Orthopaedic Nurse Test Pharmacology & Pain Management 1 — Questions and Answers
Question 1: Which class of medications works by inhibiting cyclooxygenase (COX) enzymes to reduce inflammation and pain in orthopaedic patients?
- Opioid analgesics
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (Correct answer)
- Muscle relaxants
- Tricyclic antidepressants
Correct answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs inhibit COX-1 and COX-2 enzymes, thereby reducing prostaglandin synthesis and decreasing inflammation, pain, and fever.
Question 2: A patient recovering from total knee replacement is on a PCA (patient-controlled analgesia) pump with morphine. The nurse notes a respiratory rate of 8 breaths/min and pinpoint pupils. What is the priority intervention?
- Increase the PCA basal rate
- Administer naloxone (Narcan) as prescribed (Correct answer)
- Reposition the patient and apply oxygen
- Notify the surgeon and document findings
Correct answer: Administer naloxone (Narcan) as prescribed
Respiratory depression with pinpoint pupils indicates opioid toxicity; naloxone is the opioid antagonist that rapidly reverses this life-threatening complication.
Question 3: Which anticoagulant is most commonly prescribed for venous thromboembolism (VTE) prophylaxis after total hip arthroplasty?
- Heparin (unfractionated)
- Aspirin 325 mg twice daily
- Rivaroxaban (Xarelto) (Correct answer)
- Clopidogrel (Plavix)
Correct answer: Rivaroxaban (Xarelto)
Rivaroxaban, a direct factor Xa inhibitor, is widely used for VTE prophylaxis after major joint replacement due to its predictable pharmacokinetics and oral route.
Question 4: A bisphosphonate such as alendronate is prescribed for an orthopaedic patient with osteoporosis. Which instruction is most important to include in patient teaching?
- Take with a full glass of milk to enhance absorption
- Remain upright for at least 30 minutes after taking (Correct answer)
- Take at bedtime to reduce GI side effects
- Crush the tablet if swallowing is difficult
Correct answer: Remain upright for at least 30 minutes after taking
Bisphosphonates can cause esophageal irritation and esophagitis; patients must remain upright for 30–60 minutes after ingestion to prevent reflux and mucosal damage.
Question 5: The maximum recommended daily dose of acetaminophen for an adult without liver disease is:
- 2,000 mg/day
- 3,000 mg/day
- 4,000 mg/day (Correct answer)
- 5,000 mg/day
Correct answer: 4,000 mg/day
The FDA recommends a maximum of 4,000 mg/day of acetaminophen for healthy adults, though many clinicians recommend ≤3,000 mg/day in at-risk populations.
Question 6: Which muscle relaxant is commonly used in orthopaedic settings for acute musculoskeletal spasm and carries a risk of anticholinergic side effects?
- Baclofen
- Cyclobenzaprine (Flexeril) (Correct answer)
- Tizanidine (Zanaflex)
- Methocarbamol (Robaxin)
Correct answer: Cyclobenzaprine (Flexeril)
Cyclobenzaprine has a tricyclic structure and significant anticholinergic activity, causing dry mouth, urinary retention, and sedation, which nurses must monitor.
Question 7: When administering ketorolac (Toradol) to a post-operative orthopaedic patient, the nurse should be most concerned about which potential complication with prolonged use?
- Respiratory depression
- Gastrointestinal bleeding and renal impairment (Correct answer)
- Hepatotoxicity and jaundice
- Hypertensive crisis
Correct answer: Gastrointestinal bleeding and renal impairment
Ketorolac is an NSAID that inhibits prostaglandin synthesis, increasing risk of GI bleeding and reducing renal perfusion, particularly with use beyond 5 days.
Orthopaedic Nurse Test Pharmacology & Pain Management 1
Which class of medications works by inhibiting cyclooxygenase (COX) enzymes to reduce inflammation and pain in orthopaedic patients?