CHPN Pain Management Strategies 5 — Questions and Answers
Question 1: A terminally ill patient develops opioid-induced respiratory depression. Which medication reverses this effect and what is the priority nursing concern?
- Flumazenil; monitor for sedation
- Naloxone; administer in small titrated doses to avoid precipitating severe pain and withdrawal (Correct answer)
- Neostigmine; monitor for bradycardia
- Physostigmine; monitor for seizures
Correct answer: Naloxone; administer in small titrated doses to avoid precipitating severe pain and withdrawal
Naloxone reverses opioid-induced respiratory depression, but in opioid-tolerant palliative patients it must be titrated in small doses to restore breathing without precipitating acute pain crisis or withdrawal.
Question 2: A patient rates their pain 3/10 and states they are comfortable. The nurse observes mild grimacing. What is the most appropriate action?
- Administer breakthrough opioid based on grimacing
- Document the self-report of 3/10 as the pain score and reassess per protocol (Correct answer)
- Override the patient's report and treat as 7/10
- Consult psychiatry for pain catastrophizing
Correct answer: Document the self-report of 3/10 as the pain score and reassess per protocol
Self-report remains the gold standard; a patient who states they are comfortable at 3/10 should be believed and documented accordingly, with ongoing reassessment.
Question 3: Which description best defines 'total pain' as conceptualized in palliative care?
- The highest numeric pain score recorded during a shift
- The multidimensional experience encompassing physical, psychological, social, and spiritual suffering (Correct answer)
- Pain that requires more than two opioids to control
- Pain unresponsive to all pharmacologic interventions
Correct answer: The multidimensional experience encompassing physical, psychological, social, and spiritual suffering
Dame Cicely Saunders' concept of 'total pain' recognizes that suffering in dying patients is multidimensional, requiring holistic assessment and intervention across all domains.
Question 4: A palliative nurse notes a patient's pain worsens significantly at night. Which factor should be assessed first?
- Malingering for additional opioids
- Reduced distraction, increased anxiety, and circadian variation in pain thresholds (Correct answer)
- Incorrect pain scale use at night
- Staff incompetence on night shift
Correct answer: Reduced distraction, increased anxiety, and circadian variation in pain thresholds
Nocturnal pain worsening is often multifactorial: fewer distractions amplify pain perception, anxiety peaks at night, and some pain types have circadian patterns.
Question 5: A patient on long-term opioid therapy reports that the same dose no longer provides adequate relief. This phenomenon is best described as:
- Drug addiction
- Opioid tolerance (Correct answer)
- Pseudoaddiction
- Disease progression only
Correct answer: Opioid tolerance
Opioid tolerance is the pharmacologic phenomenon in which a given dose produces less effect over time, requiring dose escalation — it is distinct from addiction.
Question 6: A patient reports their pain as burning, shooting, and electric-shock-like in quality. Which assessment finding most supports a neuropathic pain diagnosis?
- Pain that worsens with movement
- Allodynia — pain from a stimulus that does not normally cause pain (Correct answer)
- Pain that responds immediately to acetaminophen
- Pain localized to a single point
Correct answer: Allodynia — pain from a stimulus that does not normally cause pain
Allodynia (pain from non-painful stimuli such as light touch) is a hallmark feature of neuropathic pain, along with dysesthesias and hyperalgesia.
Question 7: A family member asks whether giving pain medication to a dying patient will hasten death. What is the most accurate and ethical response by the hospice nurse?
- Yes, opioids always hasten death in high doses
- Appropriately titrated opioids to relieve pain do not hasten death and are ethically supported by the principle of double effect (Correct answer)
- We cannot give opioids near death because of legal risk
- Pain medication should be withheld to prolong life
Correct answer: Appropriately titrated opioids to relieve pain do not hasten death and are ethically supported by the principle of double effect
Research consistently shows appropriately titrated opioids do not hasten death; the principle of double effect supports their use when the intent is comfort, even if some risk exists.
CHPN Pain Management Strategies 5
A terminally ill patient develops opioid-induced respiratory depression.
Which medication reverses this effect and what is the priority nursing concern?