CHPN Pain Management Strategies 3 — Questions and Answers
Question 1: A palliative nurse recognizes that a patient's pain report is inconsistent with their behavioral cues. What is the gold standard for pain assessment in cognitively intact patients?
- Behavioral observation scale
- Caregiver report
- Patient self-report (Correct answer)
- Physiological signs such as heart rate
Correct answer: Patient self-report
Patient self-report is always the gold standard for pain assessment in patients who can communicate, regardless of discrepant behavioral cues.
Question 2: When transitioning a patient from IV morphine to oral morphine, what is the correct conversion ratio (IV to oral)?
- 1:1
- 1:2
- 1:3 (Correct answer)
- 1:6
Correct answer: 1:3
IV morphine is approximately 3 times more potent than oral morphine, so the IV-to-oral conversion ratio is 1:3.
Question 3: A dying patient is unable to swallow and has moderate pain. The family refuses an IV line. Which route is most appropriate for opioid delivery?
- Rectal suppository only
- Sublingual or buccal administration (Correct answer)
- Intramuscular injection
- Holding opioids until IV access established
Correct answer: Sublingual or buccal administration
Sublingual or buccal opioid administration is a noninvasive, effective alternative when the patient cannot swallow and IV access is unavailable.
Question 4: Which tool is most appropriate for assessing pain in a hospice patient with advanced dementia who cannot verbalize?
- Numeric Rating Scale (NRS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Visual Analog Scale (VAS)
- McGill Pain Questionnaire
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
The PAINAD scale uses behavioral observation (breathing, vocalization, facial expression, body language, consolability) to assess pain in nonverbal dementia patients.
Question 5: Corticosteroids such as dexamethasone are used as adjuvant analgesics in palliative care primarily for which type of pain?
- Neuropathic burning pain
- Pain from cord compression and bone metastases with inflammatory component (Correct answer)
- Colic-type visceral pain
- Phantom limb pain
Correct answer: Pain from cord compression and bone metastases with inflammatory component
Dexamethasone reduces peritumoral edema and inflammation, making it effective for pain from spinal cord compression and bone metastases.
Question 6: A patient on opioid therapy develops severe constipation unresponsive to stimulant laxatives. Which agent specifically targets opioid-induced constipation?
- Lactulose
- Methylnaltrexone (Relistor) (Correct answer)
- Bisacodyl suppository
- Docusate sodium
Correct answer: Methylnaltrexone (Relistor)
Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that relieves opioid-induced constipation without reversing central analgesia.
Question 7: A hospice nurse notes a patient is using breakthrough opioids every 2 hours around the clock for 3 days. What does this pattern indicate?
- Opioid addiction
- Psychological pain
- Undertreated pain requiring baseline dose adjustment (Correct answer)
- Drug diversion
Correct answer: Undertreated pain requiring baseline dose adjustment
Consistent, frequent use of breakthrough opioids indicates the baseline (scheduled) dose is inadequate and the around-the-clock regimen needs titration upward.
CHPN Pain Management Strategies 3
A palliative nurse recognizes that a patient's pain report is inconsistent with their behavioral cues.
What is the gold standard for pain assessment in cognitively intact patients?