Orthopaedic Nurse Test Pharmacology & Pain Management 2 — Questions and Answers
Question 1: A patient undergoing total knee replacement receives a femoral nerve block pre-operatively. The primary purpose of this regional anesthetic technique is to:
- Prevent surgical site infection
- Provide postoperative analgesia and reduce opioid consumption (Correct answer)
- Ensure complete intraoperative anesthesia without general anesthesia
- Reduce intraoperative blood loss
Correct answer: Provide postoperative analgesia and reduce opioid consumption
Femoral nerve blocks reduce post-operative pain and opioid requirements, facilitating earlier mobilization and reducing opioid-related side effects after TKA.
Question 2: A physician orders a corticosteroid injection (triamcinolone) into an arthritic knee joint. Which post-injection instruction should the nurse provide?
- Ambulate vigorously to distribute the medication
- Avoid weight-bearing on the joint for 24–48 hours (Correct answer)
- Apply heat immediately to reduce local swelling
- Take an antibiotic prophylactically for one week
Correct answer: Avoid weight-bearing on the joint for 24–48 hours
Resting the injected joint for 24–48 hours allows the corticosteroid to exert its local anti-inflammatory effect without being dispersed by mechanical stress.
Question 3: An orthopaedic patient is receiving warfarin for DVT treatment. Which laboratory value is the primary parameter used to monitor therapeutic anticoagulation?
- Activated partial thromboplastin time (aPTT)
- International normalized ratio (INR) (Correct answer)
- Platelet count
- Anti-Xa level
Correct answer: International normalized ratio (INR)
The INR standardizes prothrombin time measurement across labs and is the gold-standard monitoring parameter for warfarin therapy.
Question 4: Gabapentin (Neurontin) is sometimes used as part of multimodal analgesia in orthopaedic surgery. Its primary mechanism of action is:
- Inhibition of COX-1 and COX-2 enzymes
- Binding to alpha-2-delta subunits of voltage-gated calcium channels (Correct answer)
- Antagonism of NMDA glutamate receptors
- Mu-opioid receptor agonism
Correct answer: Binding to alpha-2-delta subunits of voltage-gated calcium channels
Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels in the CNS, reducing neuronal excitability and central sensitization to pain.
Question 5: Which condition is an absolute contraindication to the use of NSAIDs in an orthopaedic patient?
- Mild osteoarthritis
- Severe renal impairment (CrCl < 30 mL/min) (Correct answer)
- Chronic low back pain
- Post-operative day 3 after hip replacement
Correct answer: Severe renal impairment (CrCl < 30 mL/min)
NSAIDs reduce renal prostaglandin synthesis, decreasing glomerular filtration; in patients with severe renal impairment, this can precipitate acute kidney injury.
Question 6: A patient on patient-controlled analgesia (PCA) asks why family members are not allowed to press the PCA button. The best nursing explanation is:
- The pump requires a special PIN that only the nurse knows
- Only the patient can assess their own pain level, preventing overdose (Correct answer)
- Family members may administer medication too slowly
- Hospital policy prohibits it to reduce medication waste
Correct answer: Only the patient can assess their own pain level, preventing overdose
PCA safety relies on the patient being alert enough to self-administer; a sedated patient will not press the button, providing a built-in safety mechanism that is bypassed when others press it.
Question 7: A surgeon orders prophylactic cefazolin 2 g IV for a patient undergoing spinal fusion. When should this antibiotic be administered to achieve optimal tissue levels?
- 24 hours before the scheduled procedure
- Within 60 minutes before surgical incision (Correct answer)
- Immediately after the surgical incision is made
- At the conclusion of the surgical procedure
Correct answer: Within 60 minutes before surgical incision
SCIP (Surgical Care Improvement Project) guidelines specify antibiotic prophylaxis must be infused within 60 minutes before incision to ensure adequate tissue concentration at the time of skin breach.
Orthopaedic Nurse Test Pharmacology & Pain Management 2
A patient undergoing total knee replacement receives a femoral nerve block pre-operatively.
The primary purpose of this regional anesthetic technique is to: