NUR 616 MODULE 1 EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

NUR 616 MODULE 1 EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 Pain (definition) - Answers An unpleasant sensory and emotional experience associated with actual or potential tissue damage; subjective and varies between patients and from day to day. (Ch 9) Most reliable indicator of pain - Answers Patient self-report. (Ch 9) Nociceptive pain - Answers Pain from nerve receptor stimulation after a mechanical, thermal, or chemical insult; includes somatic and visceral. (Ch 9) Somatic pain - Answers Nociceptive pain associated with muscle, skin, or bone injury; usually well localized. (Ch 9) Visceral pain - Answers Nociceptive pain affecting the internal (visceral) organs. (Ch 9) Neuropathic pain - Answers Pain caused by abnormal signal processing in the central nervous system (CNS). (Ch 9) Central neuropathic pain - Answers Pain from multiple sclerosis, spinal cord injuries, migraine, and poststroke syndrome. (Ch 9) Peripheral neuropathic pain - Answers Pain from diabetes (diabetic neuropathy) and postherpetic neuralgia. (Ch 9) Inflammatory pain - Answers Subtype of nociceptive pain from release of proinflammatory cytokines at tissue injury; acute (bruises/infection) and chronic (RA, OA). (Ch 9) Acute pain - Answers Sudden onset, usually subsides quickly; sharp, localized sensations with an identifiable cause. (Ch 9) Chronic pain - Answers Pain persisting beyond the normal expected time frame; peripheral and central sensitization of pathways occurs. (Ch 9) Cancer-related pain - Answers Pain from the malignancy itself or secondary tissue damage (tumor involvement of bone, nerves, viscera, or soft tissue). (Ch 9) Chronic noncancer pain - Answers Persistent pain in patients without cancer; examples include osteoarthritis and fibromyalgia. (Ch 9) Breakthrough pain (BTP) - Answers Transitory moderate-to-severe pain in a patient with otherwise well-controlled chronic pain; brief, lasting minutes to hours. (Ch 9) Four stages of nociception - Answers Transduction, Transmission, Perception, Modulation. (Ch 9) Transduction - Answers Nociceptor activation from mechanical/thermal/chemical injury; nerve endings activated by release of excitatory neurotransmitters. (Ch 9) Transmission - Answers Action potential carried via myelinated A-delta and unmyelinated C fibers through the dorsal root ganglia, synapsing in the dorsal horn; neurotransmitters depolarize second-order neurons. (Ch 9) A-delta vs C fibers - Answers Pain-transmitting nerve fibers; A-delta are myelinated (fast, sharp pain), C fibers are unmyelinated (slow, dull pain). (Ch 9) Perception - Answers The end result of pain transmission to the brain, where pain is consciously perceived. (Ch 9) Modulation - Answers Pain modulation at various CNS levels, mediated by serotonin and norepinephrine; endogenous opioids bind opioid receptors in periphery and CNS. (Ch 9) Peripheral sensitization - Answers Continual stimulation of peripheral pain receptors (e.g., untreated acute pain) lowers the stimulation threshold and increases nerve firing. (Ch 9) Central sensitization - Answers An amplification of neural signaling within the CNS that elicits pain hypersensitivity (Woolf, 2011). (Ch 9) Chemical mediators of pain - Answers Norepinephrine, serotonin, histamine, and polypeptides such as bradykinin, prostaglandins, and substance P. (Ch 9) NMDA receptor (in pain) - Answers Glutamate, aspartate, and substance P activate second-order neurons in the dorsal horn primarily through NMDA receptors. (Ch 9) Single-dimension pain scales - Answers Visual analog scale, numerical rating scale, and verbal description scale. (Ch 9) Multidimensional pain scales - Answers Brief Pain Inventory and Initial Pain Assessment Tool. (Ch 9) Pain assessment: Quality - Answers What the pain feels like (sharp, stabbing, burning). (Ch 9) Pain assessment: Region - Answers The location of the pain. (Ch 9) Pain assessment: Severity - Answers The intensity of the pain. (Ch 9) Pain assessment: Temporal pattern - Answers Whether the pain is constant or intermittent and whether it is associated with movement. (Ch 9) Nonopioid analgesics - Answers Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). (Ch 9) Opioid analgesics - Answers Morphine and congeners; fentanyl and congeners. (Ch 9) Naloxone - Answers An opioid antagonist used to reverse the effects of opioids. (Ch 9) Common opioid side effects - Answers Sedation, confusion, respiratory depression, itching, nausea/vomiting, and constipation. (Ch 9) Coanalgesics (adjuvants) - Answers Antidepressants, anticonvulsants, sodium-channel blockers, NMDA-receptor antagonists, skeletal muscle relaxants, and antispastic agents. (Ch 9) Adjunctive (nonpharmacologic) pain options - Answers Hot/cold therapy, massage, patient education, coping skills training, CBT, TENS, acupuncture, and mindful meditation. (Ch 9) Interventional techniques for chronic pain - Answers Injections, spinal fusion, percutaneous disc compression, radiofrequency rhizotomy, neuromodulatory therapy, vertebroplasty, and kyphoplasty. (Ch 9) Most frequent reason opioids are abused - Answers Relief of pain. (Ch 10) Opioid reward mechanism - Answers Opioids produce pleasure by activating the ventral tegmental area and releasing dopamine from the nucleus accumbens. (Ch 10) PDMP (Prescription Drug Monitoring Program) - Answers An electronic database of filled controlled-substance prescriptions that helps identify opioid misuse. (Ch 10) Opioid Risk Tool - Answers A screening tool that helps guide whether an opioid may be safely prescribed. (Ch 10) Screening before opioids - Answers All patients should be screened for opioid use disorder, and it is essential to do so before initiating opioid analgesics. (Ch 10) Methadone (in OUD) - Answers Full mu-opioid agonist with a very long half-life; reduces cravings, dulls euphoric effects of other opioids, controls pain, and is less likely to cause tolerance due to NMDA antagonism. (Ch 10/43) Buprenorphine - Answers Partial mu-opioid agonist for OUD; first medication FDA-approved to treat OUD outside an opioid treatment program (OTP). (Ch 10/43) Naltrexone (in OUD) - Answers Opioid antagonist that blocks opioids by competitive binding; long-acting injectable given monthly; NOT routinely used for chronic pain. (Ch 10/43) Medications used in OUD - Answers Buprenorphine, methadone, and naltrexone. (Ch 10) Buprenorphine and scheduled surgery - Answers For anticipated postoperative pain, buprenorphine can be discontinued or reduced while full opioid agonists are started; restart buprenorphine only after confirmed withdrawal. (Ch 10) Dividing buprenorphine for pain - Answers Divide the total daily buprenorphine dose and give it every 6 to 8 hours to take advantage of its analgesic effect. (Ch 10) Confirm-dose rule (OUD) - Answers When a patient is on buprenorphine or methadone for OUD, confirm the current dose before starting any new medication. (Ch 10) Goals of therapy (OUD + pain) - Answers Reduce/eliminate pain and treat the underlying disease, reduce/eliminate cravings, prevent relapse, manage side effects, and improve quality of life. (Ch 10) Endocannabinoid receptors - Answers CB1 and CB2 receptors. (Ch 11) Cannabinoids - best evidence - Answers Considered safe with minimal side effects and effective for chronic pain (neuropathic pain, fibromyalgia, rheumatoid arthritis, mixed chronic pain). (Ch 11) 2018 Farm Bill - Answers The Agricultural Improvement Act that legally separated marijuana and hemp. (Ch 11) Cannabis dosing principle - Answers 'Start low, go slow.' (Ch 11) THC - Answers Tetrahydrocannabinol, the psychoactive component of cannabis. (Ch 11) CBD (cannabidiol) - Answers A nonpsychoactive cannabinoid; Epidiolex is a 98% pure plant-derived oral CBD solution and the first FDA-approved plant-derived cannabis product. (Ch 11) Dronabinol (Marinol/Syndros) - Answers Synthetic THC indicated for anorexia/weight loss in AIDS patients and for chemotherapy-induced nausea and vomiting. (Ch 11) Dronabinol adverse effects - Answers Abdominal pain, dizziness, euphoria, nausea, paranoid reaction, somnolence, abnormal thinking, and vomiting. (Ch 11) Nabilone (Cesamet) - Answers Synthetic THC derivative for chemotherapy-induced nausea/vomiting refractory to conventional antiemetics; causes psychotomimetic reactions. (Ch 11) Nabilone adverse effects - Answers Early: euphoria, hypotension, impaired cognition. Delayed: depression, ataxia, orthostatic hypotension. (Ch 11) Epidiolex (CBD) indication - Answers Seizures associated with Lennox-Gastaut Syndrome or Dravet Syndrome in pediatric patients 2 years and older. (Ch 11) Sativex (nabiximols) - Answers A combination of THC and CBD indicated for moderate-to-severe spasticity due to multiple sclerosis. (Ch 11) Substance Use Disorder (SUD) - Answers Recurrent use of alcohol and/or drugs causing clinically significant impairment (health problems, disability, failure to meet major responsibilities). (Ch 43) SUD diagnostic criteria - Answers There are 11 criteria; at least 2 are required to diagnose. Mild = 2-3, moderate = 4-5, severe = 6 or more. (Ch 43) SUD pathophysiology - Answers A brain disease based on neurophysiologic reinforcement; the mesolimbic reward pathway runs from dopaminergic neurons in the VTA to the nucleus accumbens (NAc). (Ch 43) GABA in the reward pathway - Answers GABA normally controls the dopaminergic neurons; when GABA control is removed, dopamine is released, producing a pleasure response in the NAc. (Ch 43) SBIRT - Answers Screening, Brief Intervention, and Referral to Treatment. (Ch 43) Goals of SUD treatment - Answers Reduce substance use or achieve a substance-free life, maximize life functioning, and prevent/reduce the frequency and severity of relapse. (Ch 43) Most common substance of misuse - Answers Alcohol - more than half of Americans report alcohol use in the past month. (Ch 43) Risks of heavy alcohol use - Answers Stroke, hypertension, depression, esophageal cancer, and cirrhosis of the liver. (Ch 43) Alcohol withdrawal onset - Answers Symptoms may appear 6 to 12 hours after discontinuation (can also start 1 to 3 days later) and may last up to a week. (Ch 43) Mild alcohol withdrawal - Answers Anxiety, sweating, restlessness, and insomnia. (Ch 43) Moderate alcohol withdrawal - Answers Mild symptoms PLUS increased blood pressure or heart rate, confusion, and mild hyperthermia. (Ch 43) Severe alcohol withdrawal - Answers Moderate symptoms PLUS hallucinations, impaired attention, seizures, and delirium tremens. (Ch 43) Alcohol use disorder pharmacotherapy - Answers Acamprosate, disulfiram, and naltrexone. (Ch 43) Disulfiram - Answers Deters drinking by causing an unpleasant reaction when alcohol is consumed (inhibits aldehyde dehydrogenase, causing acetaldehyde buildup). (Ch 43) Acamprosate - Answers Used in alcohol use disorder to support abstinence and reduce cravings by helping restore glutamate/GABA balance. (Ch 43) Lofexidine - Answers A non-opioid adrenergic (alpha-2) agonist indicated for mitigating opioid withdrawal symptoms in adults. (Ch 43) Methadone schedule - Answers Schedule II controlled substance. (Ch 43) Naltrexone mechanism - Answers Blocks the effects of opioids by competitive binding at opioid receptors. (Ch 43) Eight-Step Prescribing Approach (source) - Answers A WHO-endorsed six-step approach plus two added steps; from Pollock et al. (2007), 'Appropriate Prescribing of Medications.' (Prescribing) Prescribing Step 1 - Answers Evaluate and clearly define the patient's problem. (Prescribing) Prescribing Step 2 - Answers Specify the therapeutic objective. (Prescribing) Prescribing Step 3 - Answers Select the appropriate drug therapy. (Prescribing) Prescribing Step 4 - Answers Initiate therapy with appropriate details and consider nonpharmacologic therapies. (Prescribing) Prescribing Step 5 - Answers Give information, instructions, and warnings. (Prescribing) Prescribing Step 6 - Answers Evaluate therapy regularly (monitor results; consider discontinuation). (Prescribing) Prescribing Step 7 - Answers Consider drug cost when prescribing. (added by authors) (Prescribing) Prescribing Step 8 - Answers Use computers and other tools to reduce prescribing errors. (added by authors) (Prescribing) Pain (definition) - Answers An unpleasant sensory and emotional experience associated with actual or potential tissue damage; subjective and varies between patients and from day to day. (Ch 9) Most reliable indicator of pain - Answers Patient self-report. (Ch 9) Nociceptive pain - Answers Pain from nerve receptor stimulation after a mechanical, thermal, or chemical insult; includes somatic and visceral. (Ch 9) Somatic pain - Answers Nociceptive pain associated with muscle, skin, or bone injury; usually well localized. (Ch 9) Visceral pain - Answers Nociceptive pain affecting the internal (visceral) organs. (Ch 9) Neuropathic pain - Answers Pain caused by abnormal signal processing in the central nervous system (CNS). (Ch 9) Central neuropathic pain - Answers Pain from multiple sclerosis, spinal cord injuries, migraine, and poststroke syndrome. (Ch 9) Peripheral neuropathic pain - Answers Pain from diabetes (diabetic neuropathy) and postherpetic neuralgia. (Ch 9) Inflammatory pain - Answers Subtype of nociceptive pain from release of proinflammatory cytokines at tissue injury; acute (bruises/infection) and chronic (RA, OA). (Ch 9) Acute pain - Answers Sudden onset, usually subsides quickly; sharp, localized sensations with an identifiable cause. (Ch 9) Chronic pain - Answers Pain persisting beyond the normal expected time frame; peripheral and central sensitization of pathways occurs. (Ch 9) Cancer-related pain - Answers Pain from the malignancy itself or secondary tissue damage (tumor involvement of bone, nerves, viscera, or soft tissue). (Ch 9) Chronic noncancer pain - Answers Persistent pain in patients without cancer; examples include osteoarthritis and fibromyalgia. (Ch 9) Breakthrough pain (BTP) - Answers Transitory moderate-to-severe pain in a patient with otherwise well-controlled chronic pain; brief, lasting minutes to hours. (Ch 9) Four stages of nociception - Answers Transduction, Transmission, Perception, Modulation. (Ch 9) Transduction - Answers Nociceptor activation from mechanical/thermal/chemical injury; nerve endings activated by release of excitatory neurotransmitters. (Ch 9)