CRNI Pain Management and Analgesic Infusion Therapy 5

Question 1

Which local anesthetic concentration is most appropriate for a patient receiving lumbar epidural analgesia where motor preservation is the priority?

Accepted Answer

Bupivacaine 0.0625–0.125% for differential sensory block

Answer

Low-concentration bupivacaine produces a differential block that reduces pain with minimal motor impairment, preserving ambulation.

Question 2

A patient receiving intrathecal ziconotide reports new-onset confusion, hallucinations, and dizziness. What is the most appropriate initial intervention?

Accepted Answer

Reduce or discontinue ziconotide and notify the prescriber

Answer

CNS adverse effects (confusion, hallucinations, dizziness) are dose-limiting toxicities of ziconotide and require dose reduction or discontinuation.

Question 3

When teaching a patient to use PCA, which instruction is most important to prevent oversedation?

Accepted Answer

Only the patient should press the button, not family members

Answer

Only the patient should activate PCA because the patient's level of consciousness serves as a built-in safety mechanism against overdose.

Question 4

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?

Accepted Answer

5–10 minutes to allow drug effect before the next dose

Answer

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.

Question 5

Which of the following is a contraindication to neuraxial analgesia?

Accepted Answer

INR of 2.8 in a patient on warfarin

Answer

An INR ≥1.5 indicates coagulopathy, which is a contraindication to neuraxial block due to the risk of epidural hematoma.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Pain Management and Analgesic Infusion Therapy 5