CAPA Pharmacology & Pain Management 4 — Questions and Answers
Question 1: A patient undergoing outpatient hernia repair receives a TAP (transversus abdominis plane) block. Which nerve fibers are primarily targeted by this regional technique?
- Thoracolumbar spinal nerves T6-L1 supplying anterior abdominal wall (Correct answer)
- Femoral nerve and lateral femoral cutaneous nerve
- Intercostal nerves T1-T5 only
- Celiac plexus sympathetic fibers
Correct answer: Thoracolumbar spinal nerves T6-L1 supplying anterior abdominal wall
TAP blocks deposit local anesthetic between the internal oblique and transversus abdominis muscles, targeting thoracolumbar nerves T6-L1 innervating the anterior abdominal wall.
Question 2: Ketamine is administered as a subanesthetic infusion (0.1-0.5 mg/kg/hr) for postoperative pain. What is its PRIMARY analgesic mechanism?
- Mu-opioid receptor agonism
- NMDA receptor antagonism blocking central sensitization (Correct answer)
- Alpha-2 adrenergic receptor agonism
- COX-2 selective inhibition
Correct answer: NMDA receptor antagonism blocking central sensitization
Subanesthetic ketamine blocks NMDA receptors, preventing glutamate-mediated central sensitization and wind-up that amplify acute pain signals.
Question 3: A patient's discharge is delayed due to uncontrolled pain rating 8/10. She received her maximum IV opioid dose. Which non-opioid intervention should the nurse prioritize NEXT?
- Apply a cold pack to the surgical site
- Administer an additional half-dose of IV morphine
- Position the patient supine and dim the lights
- Administer oral oxycodone/acetaminophen per discharge orders (Correct answer)
Correct answer: Administer oral oxycodone/acetaminophen per discharge orders
Transitioning to oral analgesics per discharge orders is the appropriate next step once IV opioid limits are reached, facilitating the transition for home pain management.
Question 4: A patient reports she took her prescribed oxycodone 5 mg and 'two extra Tylenol' at home. The nurse calculates her total acetaminophen intake. What is the maximum safe daily dose of acetaminophen for a healthy adult?
- 2,000 mg/day
- 3,000 mg/day
- 4,000 mg/day (Correct answer)
- 6,000 mg/day
Correct answer: 4,000 mg/day
The FDA-recommended maximum acetaminophen dose for healthy adults is 4,000 mg per day, though many guidelines recommend ≤3,000 mg/day for chronic use or liver risk.
Question 5: During phone follow-up after ambulatory surgery, a patient reports she has been using her opioid prescription around the clock 'just in case' rather than for actual pain. What is the MOST appropriate nursing response?
- Advise her this is acceptable to prevent breakthrough pain
- Educate her to take opioids only when pain occurs and at the lowest effective dose (Correct answer)
- Advise her to double her next dose since she took less when not in pain
- Tell her to stop opioids immediately and switch to ibuprofen only
Correct answer: Educate her to take opioids only when pain occurs and at the lowest effective dose
Opioids should be used for actual pain at the lowest effective dose; routine prophylactic dosing increases dependence risk and side effects unnecessarily.
Question 6: A PACU nurse assesses a patient using the CPOT (Critical Care Pain Observation Tool) for pain. This tool is MOST appropriate for which patient population?
- Cooperative adults who can self-report pain
- Pediatric patients under age 5
- Patients who are unable to self-report pain due to altered consciousness (Correct answer)
- Patients with chronic pain conditions
Correct answer: Patients who are unable to self-report pain due to altered consciousness
The CPOT is a behavioral pain assessment tool validated for critically ill or non-verbal patients who cannot self-report pain.
Question 7: Which route of fentanyl administration provides the FASTEST onset of action for breakthrough pain in the ambulatory postoperative patient?
- Oral tablet
- Transdermal patch
- Intranasal spray (Correct answer)
- Subcutaneous injection
Correct answer: Intranasal spray
Intranasal fentanyl absorbs rapidly through the nasal mucosa, achieving onset in 5-10 minutes — faster than oral routes and comparable to IV for breakthrough analgesia.
CAPA Pharmacology & Pain Management 4
A patient undergoing outpatient hernia repair receives a TAP (transversus abdominis plane) block.
Which nerve fibers are primarily targeted by this regional technique?