ANCC Pain Management Nursing

Question 1

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?

Accepted Answer

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

Answer

Step 1: Non-opioid analgesics only

Answer

Step 2: Mild-to-moderate opioids plus non-opioids

Answer

Step 4: Interventional pain management

Question 2

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:

Accepted Answer

Opioid withdrawal syndrome

Answer

Opioid overdose requiring naloxone

Answer

Serotonin syndrome from opioid-antidepressant interaction

Answer

Opioid-induced hyperalgesia

Question 3

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?

Accepted Answer

Total score 10: severe pain requiring immediate intervention

Answer

Total score 8: moderate pain

Answer

Total score 6: mild-to-moderate pain

Answer

Total score 10: sedation-related symptoms, not pain

Question 4

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

Accepted Answer

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

Answer

Naloxone for routine administration every 6 hours

Answer

Antiemetic prophylaxis scheduled around the clock for 30 days

Answer

Dose reduction of all other analgesics to avoid polypharmacy

Question 5

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

Accepted Answer

0.2 mL

Answer

0.4 mL

Answer

2 mL

Answer

4 mL

Question 6

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

Accepted Answer

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

Answer

Morphine PCA alone titrated to pain level

Answer

Two different opioids prescribed simultaneously for synergy

Answer

Maximizing opioid doses before adding non-opioid adjuvants