Pain Management Nursing Flashcards

A patient with chronic low back pain (7/10) takes oxycodone 10 mg every 4 hours plus acetaminophen. Which WHO analgesic ladder step does this represent?

Answer: Step 3: Strong opioids plus non-opioids with or without adjuvants

Oxycodone is a strong opioid, placing this regimen at WHO Step 3 — for moderate-to-severe pain using strong opioids (morphine, oxycodone, hydromorphone, fentanyl) with or without non-opioids and adjuvants.

A patient on chronic opioid therapy develops nausea, vomiting, diarrhea, sweating, and severe anxiety 12 hours after their last dose. This is most consistent with:

Answer: Opioid withdrawal syndrome

Opioid withdrawal presents with autonomic hyperactivity (sweating, tachycardia) and GI symptoms (nausea, vomiting, diarrhea) beginning 8-24 hours after last dose of short-acting opioids.

A FLACC assessment shows grimacing (face 2), legs drawn up (legs 2), rigid body (activity 2), crying continuously (cry 2), and inconsolable (consolability 2). Total score and clinical meaning?

Answer: Total score 10: severe pain requiring immediate intervention

FLACC scores each of 5 categories 0-2 with maximum total = 10. A score of 10 (2+2+2+2+2) indicates severe pain requiring immediate pharmacological and non-pharmacological intervention.

A patient with cancer pain is starting extended-release morphine. Which order must also be provided at initiation of scheduled opioid therapy?

Answer: Routine laxative (senna or docusate) to prevent opioid-induced constipation

Opioid-induced constipation (OIC) is the most universal and persistent opioid side effect — tolerance does NOT develop. A stimulant laxative (senna) must be prescribed prophylactically when initiating opioid therapy.

A patient is prescribed hydromorphone 0.4 mg IV every 4 hours. Available concentration is 2 mg/mL. How many mL per dose?

Answer: 0.2 mL

Volume = Dose divided by Concentration = 0.4 mg divided by 2 mg/mL = 0.2 mL. Hydromorphone is approximately 5-10 times more potent than morphine; careful dose verification is essential.

Which combination of analgesic modalities best represents a multimodal analgesia approach for a post-surgical patient?

Answer: Scheduled acetaminophen, scheduled NSAIDs (if not contraindicated), gabapentin, and opioids only as needed

Multimodal analgesia combines analgesics and techniques with different mechanisms to provide superior pain relief at lower opioid doses, reducing opioid-related side effects.