CRNI Pain Management and Analgesic Infusion Therapy 3

Question 1

A patient receiving epidural analgesia develops a respiratory rate of 7 breaths/min and cannot be aroused to voice. Which intervention is most urgent?

Accepted Answer

Administer IV naloxone and call the physician immediately

Answer

Mild pruritis at the insertion site

Answer

Sit the patient upright and apply supplemental oxygen only

Answer

Increase the lockout interval on the epidural pump

Question 2

Per infusion nursing standards, patients receiving continuous IV opioid infusions should have respiratory status assessed at minimum how often?

Accepted Answer

Every 1–2 hours

Answer

Every 30 minutes

Answer

Every 4 hours

Answer

Every 8 hours

Question 3

Intrathecal drug delivery differs fundamentally from epidural delivery in that:

Accepted Answer

Medication is delivered directly into the cerebrospinal fluid (CSF)

Answer

It requires significantly larger doses of opioids for effect

Answer

It uses only non-opioid analgesics such as clonidine

Answer

It cannot be used for chronic cancer pain management

Question 4

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?

Accepted Answer

Assess the patient, IV site patency, and tubing connections

Answer

Increase the programmed demand dose immediately

Answer

Contact the pharmacy to replace the pump

Answer

Administer a loading dose from the PCA reservoir

Question 5

When caring for a patient with an implanted intrathecal drug delivery pump, the nurse should recognize that the most serious risk is:

Accepted Answer

Catheter tip granuloma or pump programming error causing drug overdose

Answer

Superficial infection at the pump pocket incision site

Answer

Battery depletion requiring unplanned surgical replacement

Answer

Drug precipitation blocking the intrathecal catheter

Question 6

Hydromorphone (Dilaudid) is preferred over morphine for PCA in patients with renal insufficiency primarily because:

Accepted Answer

Morphine's active metabolite morphine-6-glucuronide accumulates in renal failure causing toxicity

Answer

It is significantly less potent and therefore inherently safer to use

Answer

It can be administered at lower infusion volumes

Answer

It has a substantially longer duration of action, requiring fewer doses

Question 7

A patient receiving epidural analgesia develops hypotension with a blood pressure of 82/50 mmHg. Which nursing response is most appropriate?

Accepted Answer

Stop the epidural infusion, administer an IV fluid bolus, and notify the physician

Answer

Increase the epidural infusion rate to improve sympathetic tone

Answer

Place the patient in high Fowler's position to redistribute blood flow

Answer

Document the finding and reassess in 15 minutes