A Physician's Guide to Pain and Symptom Management
Self-Study Examination
Instructions: After studying the text answer the following true/false or multiple choice questions. Remember, there's only one answer to each question.
a) Hold the conversation in a professional environment. b) Ask the patient what his former physicians told him. c) Give all the information possible. d) Break the news quickly.
a) remain silent and wait for the patient to talk b) stay strong and in control c) remind him/her not to be angry with you d) leave the room so the patient can be alone
a) delusions about cure b) fears of rejection and secrecy c) anxious, depressed feelings d) excessive attachments to caregivers
a) avoid terms like death or dying b) understand that patients will be reluctant to make decisions c) know that patients cannot decide without family input d) ask the patient what to do if he or she dies
a) they focus on curing disease b) they don’t want to think about their own death c) it can lead to legal problems with family members d) it can be a time-consuming process
a) to ask them what they want done b) an expert medical opinion is valuable c) to discuss what they each know about the patient’s wishes d) there is always time to reconsider decisions
a) true b) false
a) reassure them that prescription opioids are not the same as street drugs b) explain how it is acceptable to take insulin if one has diabetes c) remind them that they will not take the drug long enough to become addicted d) prescribe long acting forms of drugs used
a) they can function more normally if pain free b) they will know that later days will be more comfortable c) they can deal with a painful diagnosis better d) they can know how the medications will affect them later
a) constipation b) nausea c) nightmares d) doped feeling
a) use of all opioid drugs is forbidden by the Catholic church b) high doses of opioids for pain relief can contribute to a death considered suicide and unacceptable to the Catholic church c) using medication dosages that shorten life and contribute to death is considered a mortal sin in most religions d) adequate pain relief is morally acceptable to most patients if misconceptions about their religious doctrines are clarified
a) health insurance coverage is available b) he can hide the use from family members c) he may then be able to participate in his weekly golf game d) it is normal to have a low pain threshold
a) maintaining low doses of single drugs b) reassuring patients that severity of pain cannot be measured c) attempts to prevent dependence and addiction d) providing education on correct pain management
a) providing adequate nutrition b) having hospital beds available c) keeping communication channels open d) making decisions for the dying patient
a) excessive expenses b) treatment failures c) managed care interventions d) absence of needed support
a) make written lists of each one’s problems and needs in order of importance b) ask patients and families to study patient education materials together c) explain that they must talk and agree on what is to be done/when d) have psychologists talk with patients and family members separately
a) patients and families giving up b) need to work more regular hours c) side effects outweighing benefits d) problems monitoring outcomes
a) costs will be less than hospital care b) DNR status is required c) patient’s values will guide care planning d) death must be imminent
a) care is available 24 hours/day b) families are not expected to participate in care c) volunteers provide the majority of comfort care d) it is often difficult to determine when cancer patients qualify
a) when insurance will no longer pay for home care b) when patients have no in-home support system c) when patients need a break from chemotherapy d) when family members need time for relaxation
a) comply if the patient understands his request b) change the subject to discuss treatment options c) remind the patient that the request is illegal d) explain that you will help manage pain, but cannot directly kill
a) providing time away from dying patients b) giving treatment and research options to busy staff c) acknowledging that feelings are not unique d) getting colleagues to take over difficult patients
a) grieve losses b) minimize personal involvement c) carry on with pleasurable activities d) keep emotions in check
a) understand relative amount of pain expected in certain cancers b) treat all patients as if pain is intractable c) ask the patient about the presence of pain d) know if the patient has history of low pain threshold
a) family members’ assessment of presence of pain b) understanding of the expected pain for the type of pain c) categorization of stages of pain d) psychological state of patient
a) clinicians historically do not accept patient self report b) clinical studies have proven inaccuracy of self reports c) knowledge of chronic pain symptom patterns d) patient’s continued participation in usual activities
a) neuropathic b) somatic c) visceral d) generalized
a) spiritual faith and support b) feelings of being a burden on caregivers c) competence of health-care professionals d) availability of adequate pain control
a) psychotic break b) wish to die c) delirious state d) taste bud disturbance
a) lack of ability to afford care can inhibit use of pain medications b) full social history must be documented for legal protection c) insurance claims may not be necessary d) long-term needs are going to be costly
a) severe retractable pain b) neuropathic pain c) urologic pain d) bone pain
a) chronic pain b) history of long-term use c) chronic indigestion d) inflamed tissue
a) acetylsalicylic acid b) ibuprofen c) indomethacin d) ketorolac
a) heart problems b) kidney failure c) gastrointestinal disease d) cognitive disturbances
a) discard immediately upon drug expiration date b) use sparingly c) evaluate all other medications taken d) monitor platelet counts regularly
a) give higher doses if needed to control pain b) limit frequency of doses c) administer when pain becomes intolerable d) maintain prescribed schedules
a) a guide for controlling medication administration b) drugs that cannot be used safely c) signs of pain that require opioids d) a step-wise escalation of type and dosage of drugs
a) it is very addictive b) oral doses are taken too frequently c) relief of pain is too brief d) it is ineffective with adjuvant medications
a) oral b) intramuscular c) intravenous d) topical patches
a) sleepiness b) confusion c) sedation d) agitation
a) awaken with severe intractable pain b) have extremely rapid respiration c) cannot take opioid medications in the future d) not be able to excrete the drug safely
a) bone pain b) nerve ending pain c) acute spasms
a) prevent legal problems b) monitor potential addiction c) adjustment of medication dosage d) assess severity of pain
a) intermittent doses of fast-acting opioids b) counseling to understand importance of medications c) brief drug-free periods d) drug changes regularly
a) massage b) acupuncture c) alternating heat and cold packs d) application of electrical stimulators
a) to help them accept their diagnosis b) to provide comfort and support c) to dispel misconceptions d) to aid in acceptance of chemotherapy
a) lower intensity of pain b) provide distraction c) take considerable time to learn d) be helpful once a day
a) improves the atmosphere of sick room b) reassures family members c) distracts from sadness and pain d) provides life review
a) immediate feelings of pain relief b) elimination of need for pain medication c) additional caregiver support d) increased sense of well being
a) patients are often unwilling to talk b) effects of cancer are often the same as signs of depression c) pain medications often mask signs of depression d) patients often try to encourage family members
a) SSRI’s b) benzodiazepines c) sedatives d) psycho stimulants
a) increasing fluid intake b) limiting salt in the diet c) sucking sugar-free hard candies d) take medications in frequent smaller doses
a) by giving medications before and after chemotherapy b) by giving medications immediately after each treatment c) by monitoring the need for medications and titrating doses d) by using higher doses of single drugs
a) based on the prognosis b) directed at underlying cause c) recognized as unnecessary in the last days of life d) related to pain medication schedule
a) warm showers b) body lotions and oils c) cold packs d) floral scented bath gels
a) take short naps b) lie quietly in bed throughout the night c) practice guided imagery d) a glass of wine at bedtime
a) palliative care teams work only in hospice settings b) palliative care teams provide emergency services c) palliative care teams can provide care that isn’t offered by hospice d) palliative care teams are generally paid for by patients’ insurances
a) home-health service b) respite care for family members c) transportation arrangements d) staff education
a) clinical competence to relieve mental and physical pain b) ability to empathize c) skills in explaining symptoms and prognosis d) good communication skills
a) family members can be cheerful and keep the patient from losing hope if they know b) patients can give up without pressure from family members c) time to spend with patients can be planned for d) hospitalization can be arranged
a) they give up b) they refuse to talk about the future c) their pain becomes more severe d) they have long periods of sleeping
a) learning that they will have different roles from early days b) being left alone with the patient c) knowing how to provide fluids and maintain hydration d) suggestions for ways to make food appealing and easy to swallow
a) death comes to everyone b) guilt is unwarranted c) family members are relieved d) assignments can be refused
a) dealing with family members b) accepting termination of treatment c) managing symptoms d) arranging for medical supplies
a) propping patient in bed b) limiting fluid intake c) administering oxygen d) teaching mouth-breathing techniques
a) patients may have muscle pains and aching b) fluids should be provided intravenously c) caregivers can encourage small sips of fluids frequently d) patients do not experience hunger or thirst
a) unconsciousness b) hypertension c) sensitivity to noises and light d) excess thirst
a) everyone experiences grief in a similar way b) normal grief follows a predictable course c) talking about loss intensifies grief d) asking for help is acceptable