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Nurse Practitioner:
doi: 10.1097/01.NPR.0000408549.61821.ce
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Managing pain in obese patients

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INSTRUCTIONS Managing pain in obese patients

TEST INSTRUCTIONS

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Managing pain in obese patients

General Purpose: To familiarize the NP with pain management for obese patients. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. State the prevalence, contributing factors, and characteristics of obesity. 2. Describe comorbidities related to obesity and pain. 3. Discuss methods of managing pain for obese patients.

1. Approximately how many people worldwide are obese?

a. 5 million

b. 50 million

c. 1 billion

d. 5 billion

2. Which statement about pain in the obese patient is correct?

a. Pain management can assist the patient to increase activity and lose weight.

b. Obesity-related pain can be managed by lifestyle changes.

c. Pain should take priority over treatment of other obesity-related diseases.

d. Most healthcare providers frequently address pain-related comorbidities such as low back pain.

3. Which BMI is classified as normal weight?

a. 14

b. 20

c. 32

d. 37

4. Which BMI is classified as Obese Class I?

a. 14

b. 20

c. 32

d. 37

5. Which physiologic change is related to increased adipose tissue?

a. increase in interleukin-6

b. decrease in tumor necrosis factor

c. decrease in C-reactive protein

d. increase in insulin sensitivity

6. The percentage of patients with fibromyalgia who are classified as obese is as much as

a. 5%.

b. 10%.

c. 25%.

d. 50%.

7. Which characteristic is not typical of fibromyalgia pain in the obese patient?

a. chronic pain

b. affects males more than females

c. hyperalgesia in at least 11 specific points

d. bilateral pain

8. Which statement about low back pain and weight loss is accurate?

a. Bariatric surgery has demonstrated a significant decrease in low back pain.

b. Low back pain is equally reduced by all weight loss strategies.

c. Weight loss usually reverses the effect on mechanical load bearing.

d. Comprehensive multidisciplinary nonsurgical programs are as effective as surgical programs for morbidly obese patients.

9. The two major risk factors for osteoarthritis are obesity and

a. male gender.

b. female gender.

c. calcium-rich diet.

d. lack of exercise.

10. Which of the following should be considered for pain management in an obese patient with a history of type 2 diabetes who is having moderate-to-severe pain?

a. a nonsteroidal anti-inflammatory drug

b. an opioid

c. pregabalin

d. clonidine

11. Opioids for postoperative pain in most obese patients can generally be administered

a. only if other medications fail.

b. in smaller than usual doses.

c. in usual doses.

d. in larger than usual doses.

12. Which is the best combination for management of postoperative pain in the obese patient?

a. multimodal analgesia using regional and opioid-sparing modes

b. an opioid analgesic combined with a sedative

c. patient-controlled analgesia and continuous infusion

d. acupuncture and yoga

13. Recommendations for postoperative pain management for the obese patient include

a. head of bed elevation to 20 degrees.

b. endotracheal intubation.

c. oxygen saturation greater than 94% while asleep on 2 liters of oxygen.

d. end-tidal carbon dioxide monitoring.

14. Compared to a nonobese patient receiving epidural analgesia with a local anesthetic postsurgery, the obese patient will require

a. less local anesthetic.

b. the same local anesthetic.

c. slightly more local anesthetic.

d. significantly more local anesthetic.

15. Aromatherapy, using which of the following essential oils, has been shown to decrease the morphine dosage needed for postoperative pain?

a. citrus

b. lavender

c. eucalyptus

d. peppermint

16. Compared to nonobese patients, renal clearance in the morbidly obese patient is most likely to be

a. the same.

b. increased.

c. decreased.

d. unknown.

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