CRNI Pain Management and Analgesic Infusion Therapy 1 — Questions and Answers
Question 1: What is the standard lockout interval for most morphine patient-controlled analgesia (PCA) programs?
- 5–10 minutes (Correct answer)
- 15–20 minutes
- 25–30 minutes
- 30–60 minutes
Correct answer: 5–10 minutes
A 5–10 minute lockout interval is standard for IV morphine PCA, allowing time to assess the effect of each demand dose before another can be delivered.
Question 2: Which sedation assessment tool was specifically developed to monitor opioid-induced sedation in patients receiving IV analgesic infusions?
- Glasgow Coma Scale (GCS)
- Pasero Opioid-induced Sedation Scale (POSS) (Correct answer)
- Richmond Agitation-Sedation Scale (RASS)
- Ramsay Sedation Scale
Correct answer: Pasero Opioid-induced Sedation Scale (POSS)
The Pasero Opioid-induced Sedation Scale (POSS) was specifically designed to assess sedation in patients receiving opioids and guides nursing interventions based on sedation level.
Question 3: When programming a PCA pump, which set of parameters must ALL be verified to ensure safe analgesic delivery?
- Demand dose only
- Demand dose and lockout interval only
- Maximum dose limit, lockout interval, and demand dose (Correct answer)
- Basal rate and demand dose only
Correct answer: Maximum dose limit, lockout interval, and demand dose
Safe PCA programming requires verification of the demand dose, lockout interval, and maximum dose limit together to prevent inadvertent opioid overdose.
Question 4: A patient receiving IV morphine via PCA has a respiratory rate of 8 breaths/min and is difficult to arouse. What is the priority nursing intervention?
- Increase the lockout interval on the pump
- Administer naloxone and notify the physician (Correct answer)
- Decrease the demand dose and continue monitoring
- Discontinue PCA and switch to oral analgesics
Correct answer: Administer naloxone and notify the physician
Respiratory depression with decreased consciousness requires immediate administration of naloxone (opioid antagonist) and physician notification, as this is a life-threatening emergency.
Question 5: What is the primary pharmacokinetic advantage of IV patient-controlled analgesia over nurse-administered as-needed opioids?
- Lower total opioid consumption over 24 hours
- More consistent serum drug levels with less peak-and-trough sedation (Correct answer)
- Elimination of the risk of respiratory depression
- Ability to use non-opioid analgesics exclusively
Correct answer: More consistent serum drug levels with less peak-and-trough sedation
PCA maintains more stable serum opioid concentrations by allowing small frequent doses, reducing the wide peaks and troughs seen with traditional as-needed intramuscular or IV bolus dosing.
Question 6: Which route of opioid administration provides the fastest onset of analgesia in acute pain management?
- Intramuscular
- Oral
- Subcutaneous
- Intravenous (Correct answer)
Correct answer: Intravenous
The intravenous route provides the fastest onset of opioid action because the drug enters systemic circulation immediately without absorption barriers.
Question 7: A patient's family member repeatedly presses the PCA button when the patient is asleep. This practice is called 'PCA by proxy' and is dangerous primarily because:
- It causes the pump to malfunction and deliver inaccurate doses
- It bypasses the patient's own sedation response, which normally prevents self-overdose (Correct answer)
- It rapidly depletes the medication reservoir
- It causes the lockout interval to reset inappropriately
Correct answer: It bypasses the patient's own sedation response, which normally prevents self-overdose
The safety of PCA relies on the patient being awake enough to press the button; a sedated patient will not self-dose, but PCA by proxy removes this intrinsic safety mechanism, risking overdose.
CRNI Pain Management and Analgesic Infusion Therapy 1
What is the standard lockout interval for most morphine patient-controlled analgesia (PCA) programs?