ANCC Pain Management Nursing 2

Question 1

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?

Accepted Answer

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

Answer

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.

Question 2

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

Accepted Answer

Duloxetine (Cymbalta) or pregabalin (Lyrica)

Answer

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

Question 3

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

Accepted Answer

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

Answer

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

Question 4

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?

Accepted Answer

20 mg IV morphine per 24 hours

Answer

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.

Question 5

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

Accepted Answer

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

Answer

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

ANCC - American Nurses Credentialing Center Practice Test

ANCC - American Nurses Credentialing Center Practice Test

ANCC Pain Management Nursing 2