AMSN Pain Management and Palliative Care 1 — Questions and Answers
Question 1: A patient rates their post-operative pain as 8/10 and reports their current analgesic regimen is ineffective. The nurse's first action is:
- Wait until the next scheduled medication time
- Assess the pain fully using location, quality, onset, and aggravating factors, then contact the provider for orders if needed (Correct answer)
- Administer the next scheduled dose early
- Apply ice to the surgical site only
Correct answer: Assess the pain fully using location, quality, onset, and aggravating factors, then contact the provider for orders if needed
Comprehensive pain reassessment is necessary before escalating treatment to ensure the appropriate analgesic approach is selected for the type of pain.
Question 2: A patient receiving IV patient-controlled analgesia (PCA) morphine is found with a respiratory rate of 7 breaths/min and is difficult to arouse. The nurse's priority action is:
- Increase the PCA lockout interval
- Stop the PCA, administer naloxone (Narcan), and call for emergency assistance (Correct answer)
- Administer supplemental oxygen and monitor
- Reposition the patient and reassess in 15 minutes
Correct answer: Stop the PCA, administer naloxone (Narcan), and call for emergency assistance
Respiratory depression from opioid overdose is life-threatening and requires immediate PCA cessation, naloxone administration, and emergency response.
Question 3: A patient with chronic cancer pain is on scheduled long-acting opioids. The nurse's understanding of equianalgesic dosing is important when:
- Titrating antihypertensive medications
- Converting between opioid formulations or routes to maintain equivalent pain control (Correct answer)
- Calculating antibiotic dosages
- Adjusting insulin sliding scale doses
Correct answer: Converting between opioid formulations or routes to maintain equivalent pain control
Equianalgesic dosing tables allow safe conversion between different opioids or routes (oral to IV) while maintaining equivalent pain control without under- or over-dosing.
Question 4: A palliative care patient with advanced cancer has uncontrolled pain despite scheduled opioids. The nurse should advocate for the addition of:
- A lower dose of the current opioid
- A breakthrough (rescue) dose of a short-acting opioid for episodic pain (Correct answer)
- An antibiotic to reduce pain
- A benzodiazepine as the primary analgesic
Correct answer: A breakthrough (rescue) dose of a short-acting opioid for episodic pain
Breakthrough (rescue) doses of short-acting opioids are prescribed for episodic or incident pain that exceeds the relief provided by scheduled long-acting medications.
Question 5: A patient with chronic neuropathic pain is prescribed gabapentin (Neurontin). The nurse should teach the patient that this medication:
- Is an opioid analgesic that requires monitoring for respiratory depression
- Is an anticonvulsant that treats neuropathic pain by stabilizing nerve membranes; causes dizziness and somnolence (Correct answer)
- Provides immediate pain relief within minutes of administration
- Should be stopped abruptly if ineffective after one dose
Correct answer: Is an anticonvulsant that treats neuropathic pain by stabilizing nerve membranes; causes dizziness and somnolence
Gabapentin is an anticonvulsant used for neuropathic pain that works via calcium channel modulation; it requires gradual dose titration and causes dizziness and sedation.
Question 6: In the WHO analgesic ladder, which step represents the use of strong opioids for severe pain?
- Step 1 — non-opioids (acetaminophen, NSAIDs)
- Step 3 — strong opioids such as morphine or oxycodone (Correct answer)
- Step 2 — weak opioids such as codeine
- Step 4 — interventional procedures
Correct answer: Step 3 — strong opioids such as morphine or oxycodone
WHO Step 3 recommends strong opioids (morphine, oxycodone, hydromorphone) for severe pain (NRS 7–10) when Step 1 and Step 2 analgesics are inadequate.
AMSN Pain Management and Palliative Care 1
A patient rates their post-operative pain as 8/10 and reports their current analgesic regimen is ineffective.
The nurse's first action is: