CRNI Pain Management and Analgesic Infusion Therapy 2 — Questions and Answers
Question 1: When preparing medications for administration through an epidural catheter, which standard is most critical?
- The medication must be diluted in bacteriostatic normal saline
- Only preservative-free medications and solutions must be used (Correct answer)
- A 0.22-micron filter must be used for all infusions
- The solution must be warmed to body temperature before administration
Correct answer: Only preservative-free medications and solutions must be used
Preservatives such as benzyl alcohol and phenol are neurotoxic and must never be used in epidural or intrathecal spaces; only preservative-free formulations are safe.
Question 2: Which opioid is most widely used as the standard agent for IV patient-controlled analgesia in postoperative patients?
- Hydromorphone
- Fentanyl
- Morphine (Correct answer)
- Meperidine
Correct answer: Morphine
Morphine is the most widely used and studied PCA opioid for postoperative pain management and serves as the reference standard against which other opioids are compared.
Question 3: What is the maximum recommended duration of continuous IV ketorolac (Toradol) therapy in adults?
- 24 hours
- 5 days (Correct answer)
- 7 days
- 14 days
Correct answer: 5 days
IV ketorolac is limited to 5 days due to the risk of serious GI bleeding, renal toxicity, and inhibition of platelet aggregation with prolonged use.
Question 4: Multimodal analgesia is a strategy that improves pain control by:
- Using one analgesic at the maximum tolerated dose to achieve complete pain relief
- Combining agents with different mechanisms of action to achieve additive or synergistic effects (Correct answer)
- Rotating between different opioids every 24 hours to prevent tolerance
- Using only non-pharmacological interventions to reduce opioid exposure
Correct answer: Combining agents with different mechanisms of action to achieve additive or synergistic effects
Multimodal analgesia combines drugs acting on different pain pathways (e.g., opioids, NSAIDs, acetaminophen, regional blocks) to improve analgesia while reducing side effects of any single agent.
Question 5: Opioid tolerance in a patient receiving chronic analgesic infusion therapy is best described as:
- Increased sensitivity to the sedating side effects of opioids over time
- A need for progressively higher doses to achieve the same level of analgesia (Correct answer)
- Development of psychological dependence and addiction
- Decreased risk of respiratory depression with long-term opioid use
Correct answer: A need for progressively higher doses to achieve the same level of analgesia
Tolerance is a pharmacological phenomenon where repeated opioid exposure reduces receptor responsiveness, requiring dose escalation to maintain the same analgesic effect.
Question 6: A patient's pain is inadequately controlled with demand doses alone on PCA, with no basal infusion running. The appropriate first nursing action is to:
- Independently increase the programmed demand dose
- Independently add a continuous basal infusion to the PCA
- Contact the prescriber to reassess and modify the pain management plan (Correct answer)
- Decrease the lockout interval without changing the demand dose
Correct answer: Contact the prescriber to reassess and modify the pain management plan
Changing PCA parameters requires a physician order; the nurse's role is to assess, document, and communicate uncontrolled pain to the prescriber for a plan modification.
Question 7: Which medication is the pharmacological antidote for opioid-induced respiratory depression?
- Flumazenil (Romazicon)
- Naloxone (Narcan) (Correct answer)
- Protamine sulfate
- Physostigmine
Correct answer: Naloxone (Narcan)
Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression, sedation, and analgesia.
CRNI Pain Management and Analgesic Infusion Therapy 2
When preparing medications for administration through an epidural catheter, which standard is most critical?