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Managing Opioid Use in Orthopaedic Patients Through Harm Reduction Strategies

doi: 10.1097/NOR.0000000000000543
Departments: CE Tests
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Lippincott Professional Development (LPD) will award 1.5 contact hours for this continuing nursing education activity. This activity has been assigned 1.5 pharmacology credits.

LPD is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. LWW is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida #50-1223.

Disclosure: The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

This article has been approved by the Orthopaedic Nurses Certification Board for Category A credit toward recertification as an ONC.

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CE TEST QUESTIONS

GENERAL PURPOSE: To provide information on issues and strategies for prescribing opioids and caring for orthopaedic patients with substance use disorders (SUDs).

LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:

  1. Identify issues related to the effects of opioids, SUDs, and the prescribing of opioids.
  2. Select treatment strategies in caring for an orthopaedic patient with an SUD.
  1. According to the Centers for Disease Control and Prevention (CDC, 2016), opioids have only a moderate effect for pain relief with small benefits when opioid use exceeds a minimum of
    1. 12 weeks.
    2. 24 weeks.
    3. 32 weeks.
  2. As noted in the article, a risk factor for developing an SUD that can be as great as 50% is
    1. early age of first use.
    2. genetic predisposition.
    3. a highly stressful living environment.
  3. Repeated substance use inevitably results in low levels of what substance that causes a negative affect?
    1. epinephrine
    2. dopamine
    3. cortisol
  4. Injuries requiring orthopaedic care occur in patients with SUDs while under the influence at a higher rate than in the general population due to
    1. an associated predisposition to fractures.
    2. poor nutrition.
    3. impaired judgment and coordination.
  5. Which statement is true regarding a harm reduction approach to persons with SUDs?
    1. Total abstinence or cessation of use is automatically expected.
    2. Steps taken in the right direction are valued and accepted.
    3. SUD is considered a disease but also a criminal offense.
  6. In the 2015 review by Wilson et al., researchers found that harm reduction strategies
    1. improved quality of life and were cost effective.
    2. usually led to low rates of recidivism.
    3. had a higher rate of successful treatment, compared to other approaches.
  7. The 2016 CDC Guideline for opioid prescribing recommends limiting opioid prescriptions to manage acute pain to no more than
    1. 3 days.
    2. 7 days.
    3. 10 days.
  8. As noted in the article, evidence-based nonpharmacologic interventions for pain management include
    1. tai chi.
    2. Reiki.
    3. emotional freedom tapping.
  9. Opioid contracts usually include all of the following except
    1. the potential risks and benefits of treatment.
    2. a set time after which the patient will be transitioned to a non-opioid.
    3. provisions to stop prescribing if there is no treatment benefit.
  10. Which statement is true regarding motivational interviewing?
    1. The clinician gives advice about managing an SUD.
    2. The clinician offers facts to the patient about risks or consequences of substance use.
    3. Patients are assisted in coming to their own conclusions about change.
  11. The Addiction Behaviors Checklist is a 20-question instrument completed when opioids are prescribed for pain that is
    1. completed by the patient.
    2. used to document or assess for drug-seeking behavior.
    3. helpful in identifying patients who may be at risk for problematic effects of prescribed opioids.
  12. If it is determined that a patient is obtaining controlled drugs from multiple providers, the CDC (2016) recommends using the information
    1. to provide support and intervention.
    2. to share with the other providers.
    3. as a foundation to discharge a patient from care.
  13. The CDC Guideline also recommends that when prescribing opioids, clinicians should avoid doses higher than a maximum of
    1. 30 morphine milligram equivalents (MME) per day.
    2. 40 MME per day.
    3. 50 MME per day.
  14. Based on the Pain Enjoyment and General Activity Assessment Scale, an improvement of symptoms is considered clinically meaningful if it is at least
    1. 30% improvement.
    2. 40% improvement.
    3. 50% improvement.
  15. Which statement is true regarding pain treatment for a patient with an SUD?
    1. Having an SUD precludes pain treatment.
    2. Untreated pain in patients with SUDs tends to prevent relapse in those in recovery.
    3. Best practice includes a multimodal analgesia plan, including opioids, when indicated.
  16. The medication used most commonly to treat opioid withdrawal symptoms during detox for people with opioid use disorder (OUD) is
    1. suboxone.
    2. buprenorphine.
    3. methadone.
  17. Which statement is true regarding medication assisted treatment (MAT) of OUD?
    1. It has been proven to improve recovery rates.
    2. It reduces withdrawal symptoms but fails to restore neurotransmitter balance.
    3. It uses non-opioid pain medication prescribed at low daily doses to reduce cravings.
  18. The half-life of buprenorphine is
    1. 4 hours.
    2. 19 hours.
    3. 37 hours.
  19. Which statement is true regarding overdose deaths from opioids?
    1. In the United States, one person dies every 20 minutes from an opioid overdose.
    2. Overdose deaths occur when opioid receptors desensitize the brainstem to decreases in O2.
    3. Naloxone binds with opioids and inactivates them.
  20. Morgan & Jones (2018) reported that challenges to the use of naloxone to prevent overdose include the need for higher doses than usual due to the increased strength of drugs such as
    1. heroin.
    2. fentanyl and carfentanyl.
    3. morphine and codeine.
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© 2019 National Association of Orthopaedic Nurses