CPAN Pain Management Flashcards

A patient received preservative-free morphine intrathecally. For how long should the nurse monitor closely for delayed respiratory depression?

Answer: Up to 24 hours

Hydrophilic morphine spreads rostrally in the CSF and can cause delayed respiratory depression up to about 24 hours later.

A patient with stage 4 chronic kidney disease needs IV opioid analgesia in the PACU. Which opioid should the nurse question?

Answer: Morphine

Morphine's active metabolites (M3G/M6G) build up in renal failure and can cause sedation, respiratory depression, and neurotoxicity.

A patient with OSA on supplemental oxygen is receiving IV opioids. Which monitoring method detects hypoventilation earliest?

Answer: Continuous capnography (EtCO2)

Supplemental oxygen can keep SpO2 normal while CO2 rises, so capnography catches hypoventilation sooner.

A patient on long-term buprenorphine for opioid use disorder is having elective surgery. Which approach follows current best practice?

Answer: Usually continue buprenorphine and add multimodal analgesia plus higher-affinity or higher-dose full agonists as needed

Current guidance generally favors continuing buprenorphine to prevent relapse and managing acute pain with multimodal strategies.

A patient receiving a PRN IV opioid is also taking scheduled gabapentin. What should the nurse anticipate?

Answer: Higher risk of sedation and respiratory depression

The FDA warns that gabapentinoids combined with opioids increase the risk of serious respiratory depression.

After a femoral nerve block for total knee arthroplasty, which nursing precaution is most important?

Answer: Fall precautions because of quadriceps weakness

Femoral nerve blockade weakens the quadriceps, which significantly raises the risk of falls when the patient ambulates.

A visitor keeps pressing the PCA button while the patient sleeps 'so they won't wake up in pain.' What is the nurse's best response?

Answer: Explain that only the patient may press the button, and assess the patient's sedation and respirations

PCA by proxy bypasses the built-in safety of sedation-limited self-dosing and can cause oversedation and respiratory depression.