Pain Management Nursing Flashcards

A hospice patient with terminal cancer is actively dying, unconscious, and unable to swallow. Which analgesic route is most appropriate?

Answer: Use subcutaneous, IV, or transdermal routes for around-the-clock opioid coverage

When oral administration is no longer possible, subcutaneous (most common in hospice), IV, or transdermal fentanyl routes maintain analgesic coverage. Opioid dosing is never reduced or withheld based on addiction concerns at end of life.

A patient has orders for morphine 2-4 mg IV q4h PRN and ketorolac 15 mg IV q6h. Pain is 8/10, RR is 16/min, and morphine was given 2 mg 3 hours ago. Which action is most appropriate?

Answer: Administer ketorolac 15 mg IV now, as it is due on its own schedule and operates via a different mechanism

Ketorolac has a different dosing interval (q6h) and mechanism (NSAID) from morphine (opioid). If ketorolac is due on its own schedule, administering it now provides multimodal analgesia without waiting for the morphine interval to lapse.

A patient with severe refractory cancer pain has inadequate relief from high-dose systemic opioids with intolerable side effects. The palliative team recommends an intrathecal drug delivery system (IDDS). Which statement about IDDS is correct?

Answer: IDDS delivers opioids directly to the intrathecal space achieving equivalent analgesia at approximately 1/300th of the oral morphine dose

Intrathecal delivery bypasses the blood-brain barrier, achieving equivalent analgesia at approximately 1/300th of the oral morphine dose, dramatically reducing systemic side effects.

An intubated ICU patient has partial facial tightening (face 2), fully bent upper limbs with finger flexion (upper limbs 3), and is tolerating the ventilator (compliance 1). What is the BPS total score and what does it indicate?

Answer: Score 6: clinically significant pain requiring intervention

BPS total: face 2 + upper limbs 3 + ventilator compliance 1 = 6. BPS scores at or above 5 indicate significant pain requiring intervention.

A patient is prescribed a fentanyl transdermal patch 50 mcg/hr. Which teaching point is most critical for patient safety?

Answer: Never apply heat sources (heating pad, hot tub, electric blanket) over the patch as this causes life-threatening drug release

Heat significantly increases fentanyl release from transdermal patches. Fever, heating pads, hot tubs, sunbathing, and electric blankets can cause rapid fatal dose release — the most critical safety education point.

A patient with sickle cell disease in vaso-occlusive crisis reports 9/10 pain after two doses of IV hydromorphone with minimal relief. Which intervention is most appropriate to advocate for next?

Answer: Advocate for increased opioid dosing, shorter dosing intervals, or patient-controlled analgesia (PCA)

Sickle cell vaso-occlusive crisis involves severe ischemic pain requiring aggressive, patient-tailored opioid management. When standard doses are inadequate, escalation to higher doses, shorter intervals, or PCA is evidence-based.