CRNI Pain Management and Analgesic Infusion Therapy 4 — Questions and Answers
Question 1: A patient receiving epidural analgesia develops sudden onset of severe back pain and lower extremity weakness. What is the priority nursing action?
- Administer an epidural bolus dose
- Stop the epidural infusion and notify the physician immediately (Correct answer)
- Reposition the patient to a side-lying position
- Increase the rate of the epidural infusion
Correct answer: Stop the epidural infusion and notify the physician immediately
Sudden back pain with lower extremity weakness suggests epidural hematoma or abscess, requiring immediate discontinuation and emergency evaluation.
Question 2: When converting a patient from IV morphine to oral oxycodone, which principle guides the calculation?
- Use a 1:1 ratio for all opioid conversions
- Apply equianalgesic dose tables and adjust for incomplete cross-tolerance (Correct answer)
- Double the oral dose to compensate for first-pass metabolism
- Use the same total daily dose regardless of route
Correct answer: Apply equianalgesic dose tables and adjust for incomplete cross-tolerance
Equianalgesic tables provide conversion ratios, and a 25–50% dose reduction accounts for incomplete cross-tolerance when rotating opioids.
Question 3: A patient on a continuous opioid infusion has a respiratory rate of 8 breaths/min and is difficult to arouse. After stopping the infusion, what is the next step?
- Administer naloxone and prepare for repeated dosing (Correct answer)
- Apply oxygen via nasal cannula and monitor
- Perform a sternal rub to assess consciousness level
- Obtain an arterial blood gas immediately
Correct answer: Administer naloxone and prepare for repeated dosing
Opioid-induced respiratory depression with sedation requires naloxone titration; repeated dosing may be needed because naloxone's duration is shorter than most opioids.
Question 4: Which catheter tip position is considered optimal for thoracic epidural analgesia after major abdominal surgery?
- L3–L4 to cover the entire abdomen
- T6–T10 to correspond to the surgical dermatome (Correct answer)
- C7–T1 for broad sensory coverage
- L1–L2 to target the lumbar plexus
Correct answer: T6–T10 to correspond to the surgical dermatome
Placing the epidural catheter at T6–T10 targets the thoracic dermatomes corresponding to the abdominal incision for optimal analgesia.
Question 5: A nurse notices the PCA pump has delivered 48 mg of morphine in the past 4 hours against a prescribed maximum of 10 mg/hour. What should the nurse suspect first?
- Pump malfunction or programming error (Correct answer)
- Unusually high opioid tolerance in the patient
- Unauthorized button pressing by a family member
- Normal variation in patient demand
Correct answer: Pump malfunction or programming error
Delivery significantly exceeding the prescribed limit strongly suggests a pump programming error or malfunction that must be verified before other causes.
Question 6: Which assessment finding best indicates that a patient's multimodal pain regimen is effective after total knee replacement?
- Patient reports 0/10 pain at rest only
- Patient participates in physical therapy with pain rated ≤4/10 (Correct answer)
- Patient requests no additional analgesics over 24 hours
- Patient sleeps continuously without waking
Correct answer: Patient participates in physical therapy with pain rated ≤4/10
Functional pain goals — tolerating therapy with pain ≤4/10 — reflect effective multimodal analgesia better than complete pain elimination at rest.
Question 7: A patient's intrathecal drug delivery system (IDDS) is scheduled for refill. The nurse notes the reservoir volume is lower than the calculated expected volume. What does this indicate?
- Normal variation due to body temperature changes
- Possible catheter dislodgement or drug leak requiring evaluation (Correct answer)
- The patient metabolized the drug faster than expected
- The pump is operating at a higher flow rate than programmed
Correct answer: Possible catheter dislodgement or drug leak requiring evaluation
Unexpected low reservoir volume suggests catheter malfunction, dislodgement, or leak, which must be evaluated to prevent underdosing or drug granuloma risk.
CRNI Pain Management and Analgesic Infusion Therapy 4
A patient receiving epidural analgesia develops sudden onset of severe back pain and lower extremity weakness.
What is the priority nursing action?