ABPANC ABPANC Pain Management & Comfort Care 2 — Questions and Answers
Question 1: Which of the following is an opioid-sparing analgesic strategy used in Enhanced Recovery After Surgery (ERAS) protocols?
- Preoperative acetaminophen, regional nerve blocks, and scheduled NSAIDs (Correct answer)
- Postoperative morphine PCA as sole analgesic
- Withholding all analgesics until the patient is fully awake
- High-dose IV fentanyl infusion in the PACU
Correct answer: Preoperative acetaminophen, regional nerve blocks, and scheduled NSAIDs
ERAS protocols use preoperative acetaminophen loading, regional anesthesia, and scheduled NSAIDs to minimize opioid requirements and side effects.
Question 2: A PACU patient receiving IV opioids develops pruritus. Which medication is most commonly used to treat opioid-induced pruritus?
- Diphenhydramine (Benadryl) or low-dose nalbuphine (Correct answer)
- Epinephrine IM injection
- Sodium bicarbonate IV infusion
- Applying hydrocortisone cream topically
Correct answer: Diphenhydramine (Benadryl) or low-dose nalbuphine
Diphenhydramine or low-dose nalbuphine (mixed opioid agonist-antagonist) effectively treats opioid-induced pruritus without fully reversing analgesia.
Question 3: When should a PACU nurse reassess a patient's pain following IV opioid administration?
- At the time of discharge from PACU only
- 15–30 minutes after administration to evaluate analgesic effect (Correct answer)
- Only if the patient complains again spontaneously
- After 2 hours to allow full drug absorption
Correct answer: 15–30 minutes after administration to evaluate analgesic effect
IV opioids reach peak effect within 5–15 minutes, making reassessment at 15–30 minutes appropriate to evaluate efficacy and safety.
Question 4: Post-operative nausea and vomiting (PONV) is closely associated with which of the following?
- Use of regional anesthesia techniques
- Opioid administration, female gender, and history of motion sickness (Correct answer)
- Administration of IV acetaminophen
- Intraoperative use of propofol as primary anesthetic
Correct answer: Opioid administration, female gender, and history of motion sickness
PONV risk factors include opioid use, female gender, non-smoking status, and prior history of PONV or motion sickness.
Question 5: Which intervention is appropriate when a post-operative patient reports inadequately controlled pain despite receiving ordered analgesics?
- Tell the patient to wait until the next scheduled dose
- Reassess pain characteristics, explore non-pharmacologic options, and contact the provider for additional orders (Correct answer)
- Document the pain rating and plan reassessment in 4 hours
- Administer a double dose of the ordered medication
Correct answer: Reassess pain characteristics, explore non-pharmacologic options, and contact the provider for additional orders
Uncontrolled post-operative pain requires thorough reassessment, use of adjunct non-pharmacologic measures, and provider contact for additional analgesic options.
Question 6: Which route of administration provides the fastest onset of analgesia for acute post-operative pain in the PACU?
- Oral (PO)
- Intramuscular (IM)
- Intravenous (IV) (Correct answer)
- Transdermal patch
Correct answer: Intravenous (IV)
Intravenous administration provides the fastest onset of analgesic effect, making it the preferred route for acute pain management in the PACU.
ABPANC ABPANC Pain Management & Comfort Care 2
Which of the following is an opioid-sparing analgesic strategy used in Enhanced Recovery After Surgery (ERAS) protocols?