CRRN Pain Management in Rehabilitation Nursing 2 — Questions and Answers
Question 1: Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?
- Opioid analgesics
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Anticonvulsants (gabapentinoids) (Correct answer)
- Skeletal muscle relaxants
Correct answer: Anticonvulsants (gabapentinoids)
Anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica) are evidence-based first-line agents for neuropathic pain because they modulate calcium channels and reduce aberrant neuronal firing responsible for burning and shooting pain.
Question 2: A rehabilitation patient is receiving scheduled opioid analgesics for moderate-to-severe pain. Which nursing assessment finding requires immediate intervention?
- Mild constipation requiring a bowel regimen
- Respiratory rate of 8 breaths per minute with decreased arousal (Correct answer)
- Mild nausea after morning dose
- Dry mouth reported during medication teaching
Correct answer: Respiratory rate of 8 breaths per minute with decreased arousal
Respiratory depression with decreased level of consciousness is the most life-threatening adverse effect of opioid analgesics and requires immediate intervention, including administration of naloxone (Narcan) and supportive care.
Question 3: What is the maximum recommended daily dose of acetaminophen for a healthy adult patient in a rehabilitation setting?
- 2,000 mg/day
- 3,000 mg/day
- 4,000 mg/day (Correct answer)
- 6,000 mg/day
Correct answer: 4,000 mg/day
The maximum recommended daily dose of acetaminophen for healthy adults is 4,000 mg/day; however, many clinicians and guidelines recommend limiting to 3,000 mg/day in elderly patients or those with liver disease risk to prevent hepatotoxicity.
Question 4: A rehabilitation patient prescribed methadone for chronic pain management requires close monitoring because methadone:
- Has a short and predictable half-life of 2 to 4 hours
- Is approved only for opioid use disorder and not for pain
- Has a long and variable half-life that increases risk of accumulation (Correct answer)
- Does not cause respiratory depression at therapeutic doses
Correct answer: Has a long and variable half-life that increases risk of accumulation
Methadone has a highly variable and prolonged half-life (8–59 hours) that can lead to drug accumulation and delayed respiratory depression, making careful dose titration and monitoring essential in rehabilitation settings.
Question 5: A rehabilitation nurse is teaching a patient about the risks of long-term NSAID use. Which adverse effect is of greatest concern for patient safety?
- Hyperkalemia leading to cardiac dysrhythmia
- Gastrointestinal bleeding and peptic ulcer formation (Correct answer)
- Hyperglycemia requiring insulin adjustment
- Peripheral neuropathy causing sensory deficits
Correct answer: Gastrointestinal bleeding and peptic ulcer formation
Long-term NSAID use inhibits prostaglandin synthesis, which reduces protective gastric mucosa production, significantly increasing the risk of gastrointestinal bleeding and peptic ulcer disease, especially in older rehabilitation patients.
Question 6: Tricyclic antidepressants (TCAs) such as amitriptyline are sometimes prescribed for rehabilitation patients with chronic pain primarily because they:
- Work exclusively as antidepressants to improve mood and pain tolerance
- Have demonstrated analgesic properties for neuropathic and central pain (Correct answer)
- Significantly increase opioid receptor sensitivity to reduce opioid doses
- Eliminate the need for participation in physical therapy
Correct answer: Have demonstrated analgesic properties for neuropathic and central pain
TCAs have analgesic properties independent of their antidepressant effects, modulating norepinephrine and serotonin reuptake to inhibit pain signal transmission in the spinal cord, making them effective adjuvant analgesics for neuropathic pain.
Question 7: A patient in rehabilitation is using a fentanyl transdermal patch for chronic pain management. Which instruction is most important for the nurse to include in patient education?
- Apply the patch to a hairy area of skin to improve absorption
- Change the patch every 12 hours for consistent pain control
- Apply the patch to a clean, dry, non-irritated flat skin surface (Correct answer)
- Applying a heating pad over the patch will not affect drug absorption
Correct answer: Apply the patch to a clean, dry, non-irritated flat skin surface
Fentanyl transdermal patches must be applied to clean, dry, non-irritated, flat skin to ensure consistent absorption; heat sources over the patch increase drug absorption and can cause fatal overdose due to accelerated fentanyl release.
CRRN Pain Management in Rehabilitation Nursing 2
Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?