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OR Nurse:
doi: 10.1097/01.ORN.0000407826.68399.05
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New thinking about postoperative pain management

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INSTRUCTIONS New thinking about postoperative pain management

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* Registration deadline is Decmber 31, 2013.

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New thinking about postoperative pain management

GENERAL PURPOSE: To provide nurses with an overview of postoperative pain management. LEARNING OBJECTIVES: After reading the preceding article and taking this test, you should be able to: 1. Discuss the pathophysiology of postoperative pain. 2. Describe the nurse's role in postoperative pain management. 3. Identify options for effective delivery of postoperative analgesia.

1. Which statement is correct about pain?

a. About 50% of patients report unrelieved postoperative pain.

b. Most patients with postoperative pain describe it as mild to moderate.

c. Patients' satisfaction with the surgical experience isn't influenced by their level of pain in the immediate postoperative period.

d. The intensity of pain is the same regardless of surgical type.

2. Postoperative pain management should begin

a. whenever the patient first experiences pain.

b. intraoperatively when anesthesia is given.

c. preoperatively with the patient's history.

d. in the PACU.

3. Intraoperative pressure ulcer formation can be prevented by all of the following except

a. padding bony prominences.

b. avoiding pooled liquids under the patient.

c. monitoring skin integrity.

d. sliding the patient slowly on the OR table for proper positioning.

4. Pain management in the PACU should include

a. avoiding I.V. boluses of opioids.

b. starting PCA before the patient awakes.

c. avoiding application of heat or cold.

d. multimodal approaches.

5. What is the relationship of mu receptors and opioids?

a. Opioids are classed as mu-antagonist drugs.

b. Genetics determines the degree of affinity of a patient's mu receptors for certain opioids.

c. Responsive mu-binding sites reduce analgesic effects.

d. A heterozygous morphine-sensitive genetic variant blocks analgesic effects.

6. In women, estrogen affects pain relief by

a. decreasing the number of mu-receptor sites.

b. increasing pain tolerance.

c. decreasing opioid adverse effects.

d. favoring lipophilic drugs.

7. Which statement is correct about PCA use?

a. PCA should not be used with opioid-tolerant patients.

b. The Joint Commission recommends checking pump settings once per shift.

c. Loading doses violate PCA safety guidelines.

d. PCA should be considered a process not just a delivery mechanism.

8. Which patient is most at risk for respiratory depression?

a. 35-year-old male post knee surgery

b. a patient who has had a recent large weight loss

c. 75-year-old female post laparoscopic cholecystectomy

d. a patient with a prescription for 0.5 mg morphine boluses

9. For patients at risk for respiratory depression,

a. monitor respiratory rate every 4 hours for 48 hours after surgery.

b. decrease monitoring during nighttime hours to promote adequate sleep.

c. use a basal infusion during nighttime hours.

d. include depth and rhythm in the respiratory assessment.

10. A drawback of monitoring pulse oximetry during PCA use is

a. concurrent use of capnography with pulse oximetry interferes with oximetry readings.

b. supplemental oxygen can alter the accuracy of readings.

c. readings are inaccurate below 85% oxygen saturation.

d. opioids will falsely raise oxygen saturation levels.

11. Patient-controlled epidural analgesia

a. requires a large dose of medication for pain relief.

b. is becoming increasingly popular in acute care.

c. is mostly used for major surgeries.

d. is inappropriate for fragile patients.

12. Using gabapentin in surgical patients has been shown to

a. be ineffective for pain control.

b. reduce sedation.

c. reduce nausea and vomiting due to opioids.

d. create amnesia related to the surgery.

13. Using a peripheral nerve block catheter after surgery

a. extends the effect of a nerve block.

b. is contraindicated with PCA.

c. is effective after abdominal surgery but not orthopedic surgery

d. requires an electronic pump to deliver the medication.

14. Listening to music postoperatively can

a. improve pulmonary function.

b. activate GABA.

c. activate spinal opioid receptors.

d. enhance sleep.

15. Older patients may need adjusted opioid doses because

a. they become opioid-tolerant more quickly.

b. they have decreased renal excretion.

c. they have an increased muscle-to-fat ratio.

d. they need longer-acting medications.

16. Which analgesic is the best choice for older postoperative patients?

a. meperidine

b. indomethacin

c. morphine

d. amitriptyline

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