CAPA Pharmacology & Pain Management 2

Question 1

A patient in the PACU reports pain rated 7/10 after ambulatory knee arthroscopy. They received fentanyl intraoperatively. Which multimodal analgesic agent is MOST appropriate to add first?

Accepted Answer

Ketorolac 15-30 mg IV

Answer

Ketorolac is a first-line NSAID adjunct in multimodal analgesia that reduces opioid requirements without causing respiratory depression.

Question 2

Which opioid characteristic makes methadone particularly challenging to use for acute postoperative pain management in the ambulatory setting?

Accepted Answer

Prolonged and unpredictable half-life up to 150 hours

Answer

Methadone's prolonged and variable half-life (24-150 hours) creates risk for delayed respiratory depression, making it unsuitable for ambulatory acute pain.

Question 3

A patient is prescribed gabapentin 300 mg preoperatively as part of a multimodal analgesia protocol. What is the PRIMARY mechanism by which gabapentin reduces postoperative pain?

Accepted Answer

Blockade of voltage-gated calcium channels reducing neuronal excitability

Answer

Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels, reducing presynaptic neurotransmitter release and central sensitization.

Question 4

A 65-year-old patient with renal impairment (CrCl 25 mL/min) requires analgesia after ambulatory cataract surgery. Which analgesic choice is MOST concerning?

Accepted Answer

Ketorolac 30 mg IV

Answer

Ketorolac is contraindicated in significant renal impairment because NSAIDs reduce prostaglandin-mediated renal perfusion and can precipitate acute kidney injury.

Question 5

During PACU assessment, a patient shows signs of opioid-induced pruritus after morphine administration. Which agent is MOST effective for treating this side effect while minimally reversing analgesia?

Accepted Answer

Nalbuphine 2.5-5 mg IV

Answer

Nalbuphine, a mixed agonist-antagonist, treats opioid-induced pruritus by antagonizing mu receptors while preserving analgesia via kappa receptor agonism.

(CAPA) Certified Ambulatory Perianesthesia Nurse Practice Test

(CAPA) Certified Ambulatory Perianesthesia Nurse Practice Test

CAPA Pharmacology & Pain Management 2