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
Which local anesthetic concentration is most appropriate for a patient receiving lumbar epidural analgesia where motor preservation is the priority?
Answer: Bupivacaine 0.0625–0.125% for differential sensory block
Low-concentration bupivacaine produces a differential block that reduces pain with minimal motor impairment, preserving ambulation.
A patient receiving intrathecal ziconotide reports new-onset confusion, hallucinations, and dizziness. What is the most appropriate initial intervention?
Answer: Reduce or discontinue ziconotide and notify the prescriber
CNS adverse effects (confusion, hallucinations, dizziness) are dose-limiting toxicities of ziconotide and require dose reduction or discontinuation.
When teaching a patient to use PCA, which instruction is most important to prevent oversedation?
Answer: Only the patient should press the button, not family members
Only the patient should activate PCA because the patient's level of consciousness serves as a built-in safety mechanism against overdose.
A CRNI is calculating the lockout interval for a hydromorphone PCA. The onset of IV hydromorphone is approximately 5 minutes. Which lockout interval is most appropriate?
Answer: 5–10 minutes to allow drug effect before the next dose
A 5–10 minute lockout allows enough time for hydromorphone to reach peak effect before the patient can request another dose, balancing efficacy and safety.
Which of the following is a contraindication to neuraxial analgesia?
Answer: INR of 2.8 in a patient on warfarin
An INR ≥1.5 indicates coagulopathy, which is a contraindication to neuraxial block due to the risk of epidural hematoma.
A patient on chronic buprenorphine therapy is admitted for postoperative pain management. Which approach best addresses their analgesic needs?
Answer: Continue buprenorphine and add non-opioid multimodal analgesics plus possible supplemental opioids
Continuing buprenorphine prevents withdrawal while multimodal agents and high-affinity full agonists (e.g., hydromorphone) can provide additional analgesia for acute pain.
Which parameter should a CRNI monitor most closely in a patient receiving epidural fentanyl, compared to epidural morphine?
Answer: Early respiratory depression within 30–60 minutes of administration
Fentanyl is lipophilic, causing early respiratory depression within 30–60 minutes rather than the delayed (6–24 hour) pattern seen with hydrophilic morphine.