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Suggested CE questions for R. Sinatra article
CONTACT HOUR TEST SECTION
S33
15. Nociception can be altered by which of the following drugs and/or methods? a. Cyclooxygenase-2 inhibitors (for example, rofecoxib) b. Nonsteroidal antiinflammatory drugs c. Opioids d. Local anesthetics e. All of the above 16. Binding of opioids to kappa-opioid receptors in the GI tract is mainly responsible for the adverse effects of opioids in that organ (eg, POI). a. True b. False 17. Which of the following best describes the difference between tertiary and quaternary opioid-receptor antagonists? a. Tertiary antagonists have an unoccupied (uncharged) amine group; quaternary antagonists have a charged (fully bonded) amine group b. Tertiary agents can bind three opioid molecules; quaternary agents can bind four opioid molecules c. Tertiary antagonists can bind to only 3 of the 4 major types of opioid receptors; quaternary antagonists strongly bind to all 4 types d. Tertiary antagonists cannot pass the blood– brain barrier (BBB); quaternary antagonists pass the BBB freely 18. Based on the information in this issue, which of the following is probably true? a. Careful use of a select anesthesia or analgesia option can provide adequate pain relief and prevent POI in most patients b. Reductions of nausea seen in phase 3 trials of alvimopan may be the result of its binding to mu-opioid receptors in the GI tract c. The nociception pain pathway is poorly understood, hindering the development of effective drugs for pain management d. The new peripherally acting mu-opioid-receptor antagonists, methylnaltrexone and alvimopan, have each demonstrated effectiveness in shortening the duration of POI in phase 3 clinical trials 19. In the following sets of words and/or phrases, which second word or phrase accurately reflects an activity and/or characteristic of the first as described in this issue? a. Naloxone; BBB-impermeable b. Methylnaltrexone; oral formulation c. Alvimopan; preservation of analgesia d. Rofecoxib; inhibition of cyclooxygenase-1 20. In studies 302 and 313 (article by Sinatra), postoperative management approaches (eg, intravenous patient-controlled analgesia with opioids, intraoperative nasogastric tubes removed soon after surgery, and/or early feeding) were optimized only for those who did not receive alvimopan. a. True b. False
S34
CONTACT HOUR TEST SECTION
21. According to information in this issue, which of the following is a particularly important potential indicator of the consistent efficacy of fast-track multimodal approaches? a. Preservation of opioid-mediated analgesia b. Pain score following surgery c. Degree of reduction of POI by peripherally acting mu-opioid-receptor antagonists d. Rates of hospital readmission following discharge after postoperative recovery 22. Based on the information in this issue, which of the following statements is supported? a. Total patient management is a job best left to house physicians. b. There are no clinical trial data to suggest nursing personnel can make important patient management decisions. c. Preoperative assessments made by properly trained nurses can affect postoperative management. d. Preoperative assessments need only be made by a single member of the surgical team. 23. Hospitalization length of stay is only affected by management approaches taken after surgery; preoperative evaluation, no matter how thorough, makes little impact on postoperative length of stay. a. True b. False 24. Regarding good preoperative evaluation to specifically help reduce the risk of POI, which of the following groups of assessment approaches might have the greatest potential impact? a. Assess general health, medical history, and mobility issues b. Identify and assess physical handicaps, including psychological problems such as depression c. Assess individual bowel elimination patterns and history of constipation with prior surgery d. Choices (a) and (b) might have the greatest potential to specifically help reduce the risk of POI e. Choices (a) and (c) might have the greatest potential to specifically help reduce the risk of POI 25. Peripherally acting mu-opioid-receptor antagonists may be useful in preoperative evaluation protocols because ______. a. They can be substituted for opioids for pain management b. They may reduce the incidence of opioid-mediated POI while still allowing the use of postoperative opioids for pain c. They make GI mu-opioid-receptors more susceptible to opioid binding d. They are needed to prepare the patient for alternate anesthesia regimens 26. Because surgical practice is rapidly changing so that most patients can now reasonably be expected to recover and go home sooner, PACU nurses may need to be more vigilant to help patients maintain a healthy bowel. a. True b. False
S33
15. Nociception can be altered by which of the following drugs and/or methods? a. Cyclooxygenase-2 inhibitors (for example, rofecoxib) b. Nonsteroidal antiinflammatory drugs c. Opioids d. Local anesthetics e. All of the above 16. Binding of opioids to kappa-opioid receptors in the GI tract is mainly responsible for the adverse effects of opioids in that organ (eg, POI). a. True b. False 17. Which of the following best describes the difference between tertiary and quaternary opioid-receptor antagonists? a. Tertiary antagonists have an unoccupied (uncharged) amine group; quaternary antagonists have a charged (fully bonded) amine group b. Tertiary agents can bind three opioid molecules; quaternary agents can bind four opioid molecules c. Tertiary antagonists can bind to only 3 of the 4 major types of opioid receptors; quaternary antagonists strongly bind to all 4 types d. Tertiary antagonists cannot pass the blood– brain barrier (BBB); quaternary antagonists pass the BBB freely 18. Based on the information in this issue, which of the following is probably true? a. Careful use of a select anesthesia or analgesia option can provide adequate pain relief and prevent POI in most patients b. Reductions of nausea seen in phase 3 trials of alvimopan may be the result of its binding to mu-opioid receptors in the GI tract c. The nociception pain pathway is poorly understood, hindering the development of effective drugs for pain management d. The new peripherally acting mu-opioid-receptor antagonists, methylnaltrexone and alvimopan, have each demonstrated effectiveness in shortening the duration of POI in phase 3 clinical trials 19. In the following sets of words and/or phrases, which second word or phrase accurately reflects an activity and/or characteristic of the first as described in this issue? a. Naloxone; BBB-impermeable b. Methylnaltrexone; oral formulation c. Alvimopan; preservation of analgesia d. Rofecoxib; inhibition of cyclooxygenase-1 20. In studies 302 and 313 (article by Sinatra), postoperative management approaches (eg, intravenous patient-controlled analgesia with opioids, intraoperative nasogastric tubes removed soon after surgery, and/or early feeding) were optimized only for those who did not receive alvimopan. a. True b. False
S34
CONTACT HOUR TEST SECTION
21. According to information in this issue, which of the following is a particularly important potential indicator of the consistent efficacy of fast-track multimodal approaches? a. Preservation of opioid-mediated analgesia b. Pain score following surgery c. Degree of reduction of POI by peripherally acting mu-opioid-receptor antagonists d. Rates of hospital readmission following discharge after postoperative recovery 22. Based on the information in this issue, which of the following statements is supported? a. Total patient management is a job best left to house physicians. b. There are no clinical trial data to suggest nursing personnel can make important patient management decisions. c. Preoperative assessments made by properly trained nurses can affect postoperative management. d. Preoperative assessments need only be made by a single member of the surgical team. 23. Hospitalization length of stay is only affected by management approaches taken after surgery; preoperative evaluation, no matter how thorough, makes little impact on postoperative length of stay. a. True b. False 24. Regarding good preoperative evaluation to specifically help reduce the risk of POI, which of the following groups of assessment approaches might have the greatest potential impact? a. Assess general health, medical history, and mobility issues b. Identify and assess physical handicaps, including psychological problems such as depression c. Assess individual bowel elimination patterns and history of constipation with prior surgery d. Choices (a) and (b) might have the greatest potential to specifically help reduce the risk of POI e. Choices (a) and (c) might have the greatest potential to specifically help reduce the risk of POI 25. Peripherally acting mu-opioid-receptor antagonists may be useful in preoperative evaluation protocols because ______. a. They can be substituted for opioids for pain management b. They may reduce the incidence of opioid-mediated POI while still allowing the use of postoperative opioids for pain c. They make GI mu-opioid-receptors more susceptible to opioid binding d. They are needed to prepare the patient for alternate anesthesia regimens 26. Because surgical practice is rapidly changing so that most patients can now reasonably be expected to recover and go home sooner, PACU nurses may need to be more vigilant to help patients maintain a healthy bowel. a. True b. False