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Multimodal Pain Management for Major Joint Replacement Surgery

doi: 10.1097/NOR.0000000000000545
Departments: CE Tests
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  • Read the article on page 150.
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Registration Deadline: March 5, 2021

Provider Accreditation:

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 multimodal pain management in patients who undergo major joint replacement surgery.

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

  1. Summarize the physiologic response to pain and the pharmacokinetics of selected pain medications.
  2. Recognize potential risks of various drugs used for pain management.
  3. Identify potential benefits of a multimodal approach to pain management in patients who undergo major joint replacement surgery.
  1. A patient's physiologic response to pain includes activation of the body's sympathetic nervous system, resulting in
    1. an acceleration of the gastrointestinal tract.
    2. increased oxygen consumption.
    3. decreased blood pressure.
  2. In the 2017 study by Cooney & Broglio, opioid-tolerant patients or patients who received opioids on a daily basis often developed
    1. a higher rate of drug interactions.
    2. an exaggerated pain hypersensitivity.
    3. peripheral neuropathy.
  3. Consensus guidelines reported by Schwenk et al. (2018) support the use of what drug at subanesthetic doses as a perioperative pain adjunct for opioid-tolerant patients due to its potent analgesic properties?
    1. ketamine
    2. chlorpromazine
    3. propofol
  4. In a study of more than 1 million opioid-naïve patients, Brat et al. (2018) noted that each opioid refill increased the potential for opioid misuse by more than
    1. 20%.
    2. 30%.
    3. 40%.
  5. Which class of drugs used in a multi-modal analgesic approach to surgical pain control alters neurotransmission in the dorsal horn of the spinal cord?
    1. gabapentinoids
    2. continuous peripheral nerve blocks
    3. N-methyl-D-aspartate (NMDA) antagonists
  6. In the 2018 study by Memtsoudis et al., NSAIDs as part of a multi-modal regimen for patients following hip or knee arthroplasties resulted in
    1. higher patient satisfaction scores.
    2. fewer admissions to rehabilitation facilities.
    3. decreased opioid consumption.
  7. The use of NSAIDs increases the patient's risk for
    1. pancreatitis.
    2. renal failure.
    3. pericarditis.
  8. Which statement is true regarding ketamine?
    1. It is a dissociative agent and potent analgesic.
    2. An intravenous (IV) infusion of ketamine is contraindicated in patients with sleep apnea.
    3. The common dosage of an intraoperative IV ketamine bolus ranges from 3 to 5 mg/kg.
  9. Compared to patients who did not receive gabapentin in the study by Clarke et al. (2014), patients who had lower extremity surgery and received gabapentin preoperatively as well as postoperatively had
    1. higher rates of ileus.
    2. lower rates of confusion.
    3. lower pain scores.
  10. The use of gabapentin to treat or prevent pain may be associated with
    1. seizures.
    2. drowsiness.
    3. cough.
  11. Compared to a single-shot technique, Arsoy et al. (2017) reported that the use of indwelling catheters for a continuous peripheral nerve block (CPNB) was associated with earlier
    1. urinary catheter removal.
    2. advancement of the diet.
    3. joint mobility.
  12. As reported by Ulrich et al. (2014), a longer-acting formulation of local anesthetic that allows for sustained release of the anesthetic is
    1. liposomal.
    2. topical.
    3. a microemulsion.
  13. One of the most common complications of lower extremity CPNBs is
    1. infiltration.
    2. catheter embolus.
    3. falls.
  14. Nicolotti et al. (2016) reported that a patient with a PNB in place for more than 48 hours is at increased risk for catheter site
    1. hematoma.
    2. infection.
    3. pain.
  15. As noted in the article, acetaminophen is considered safe and effective at a dosage of less than
    1. 2 grams per day.
    2. 3 grams per day.
    3. 4 grams per day.
  16. Gaffney et al. (2017) cautioned that healthcare providers should consider the side effects of medications used in pain management, especially in
    1. elderly patients.
    2. diabetic patients.
    3. opioid-tolerant patients.
  17. As noted by Parvizi & Bloomfield (2013), long-acting opioids are associated with
    1. tremors.
    2. diaphoresis.
    3. urinary retention.
  18. Non-pharmacological pain control methods noted in the article include the use of
    1. massage.
    2. ice.
    3. hypnosis.
  19. In a 2018 study by Trasolini et al., the inclusion of routine post-discharge follow-up calls from nurses aided in
    1. reducing readmissions.
    2. decreasing the rate of addiction to opioids.
    3. recognizing the need for in-home services.
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