Pain Management Nursing Flashcards

A patient on a PCA pump is found difficult to arouse with respiratory rate 8/min and pinpoint pupils. Which nursing action is the immediate priority?

Answer: Stop the PCA, stimulate the patient, provide supplemental oxygen, and prepare naloxone

The patient shows opioid-induced respiratory depression: somnolence, RR below 10, pinpoint pupils. Immediate actions: stop the PCA, stimulate the patient, apply oxygen, prepare naloxone 0.4 mg IV, notify provider stat.

A patient with neuropathic pain from diabetic peripheral neuropathy needs medication. Which first-line agent is most evidence-supported?

Answer: Duloxetine (Cymbalta) or pregabalin (Lyrica)

First-line treatments for diabetic peripheral neuropathy per ADA, AAN, and NeuPSIG guidelines are duloxetine (SNRI), pregabalin (alpha-2-delta ligand), or gabapentin.

Which mnemonic is most useful for performing a comprehensive pain assessment?

Answer: OLDCARTS (Onset, Location, Duration, Character, Alleviating/Aggravating factors, Radiation, Timing, Severity)

OLDCARTS is a comprehensive pain assessment mnemonic covering all essential dimensions: Onset, Location, Duration, Character, Alleviating/Aggravating factors, Radiation, Timing, and Severity.

A patient takes oxycodone 30 mg orally every 12 hours and is switching to IV morphine. What IV morphine dose per 24 hours is approximately equivalent?

Answer: 20 mg IV morphine per 24 hours

Total daily oral oxycodone = 60 mg. Converting to OME: 60 mg x 1.5 = 90 mg oral morphine/24hr. Converting oral to IV (3:1): 90/3 = 30 mg IV morphine/24hr. After 25-30% dose reduction for incomplete cross-tolerance: approximately 20-22 mg IV morphine/24hr.

Which validated screening tool is most appropriate for assessing opioid use disorder risk before initiating chronic opioid therapy?

Answer: ORT (Opioid Risk Tool) or DIRE (Diagnosis, Intractability, Risk, Efficacy) score

The ORT and DIRE score are validated instruments specifically designed to predict opioid misuse risk in patients being considered for chronic opioid therapy.

A patient receiving epidural analgesia develops sudden onset lower extremity weakness and urinary retention. Which nursing action is the immediate priority?

Answer: Stop the epidural infusion, notify the provider immediately, and prepare for emergency MRI

New-onset bilateral lower extremity weakness and urinary retention with epidural raises immediate concern for epidural hematoma or abscess — neurosurgical emergencies requiring urgent MRI. Delay can cause permanent paralysis.