Pain Management and Analgesic Infusion Therapy Flashcards
7 cards from real CRNI practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Pain Management and Analgesic Infusion Therapy flashcards as text
A patient receiving epidural analgesia develops a respiratory rate of 7 breaths/min and cannot be aroused to voice. Which intervention is most urgent?
Answer: Administer IV naloxone and call the physician immediately
Epidural opioids can cause delayed respiratory depression; respiratory rate below 8 with unarousable sedation is a medical emergency requiring naloxone and immediate physician notification.
Per infusion nursing standards, patients receiving continuous IV opioid infusions should have respiratory status assessed at minimum how often?
Answer: Every 1–2 hours
Infusion Nurses Society (INS) standards recommend respiratory assessment at minimum every 1–2 hours for patients on continuous opioid infusions to detect early respiratory depression.
Intrathecal drug delivery differs fundamentally from epidural delivery in that:
Answer: Medication is delivered directly into the cerebrospinal fluid (CSF)
Intrathecal delivery places medication directly into the subarachnoid space within the CSF, allowing much smaller doses to achieve analgesia compared to epidural or IV routes.
A nurse notes that a patient's PCA pump shows zero patient-activated demands in the past 8 hours, yet the patient reports severe uncontrolled pain. What is the priority assessment?
Answer: Assess the patient, IV site patency, and tubing connections
Zero demand dose deliveries with reported pain suggests a mechanical problem such as an occluded IV site, kinked tubing, or pump malfunction — assessment of the patient and system integrity comes first.
When caring for a patient with an implanted intrathecal drug delivery pump, the nurse should recognize that the most serious risk is:
Answer: Catheter tip granuloma or pump programming error causing drug overdose
Programming errors and catheter tip inflammatory mass (granuloma) are the most serious complications of intrathecal pumps as they can cause catastrophic overdose or loss of analgesia.
Hydromorphone (Dilaudid) is preferred over morphine for PCA in patients with renal insufficiency primarily because:
Answer: Morphine's active metabolite morphine-6-glucuronide accumulates in renal failure causing toxicity
Morphine-6-glucuronide, an active analgesic metabolite of morphine, accumulates in renal failure and can cause prolonged sedation and respiratory depression; hydromorphone's metabolite is less clinically active.
A patient receiving epidural analgesia develops hypotension with a blood pressure of 82/50 mmHg. Which nursing response is most appropriate?
Answer: Stop the epidural infusion, administer an IV fluid bolus, and notify the physician
Epidural opioids and local anesthetics can cause hypotension through sympathetic blockade; stopping the infusion, giving IV fluids for volume support, and notifying the physician are the appropriate initial interventions.