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Treating Acute Pain in the Hospitalized Patient

doi: 10.1097/01.NPR.0000418467.54125.24
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INSTRUCTIONS Treating acute pain in the hospitalized patient


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Treating acute pain in the hospitalized patient

General Purpose: To provide the nurse practitioner with an overview of multimodal options for analgesia for acute pain in the hospitalized patient. Learning Objectives: After reading this article and taking the test, you should be able to: 1. Define pain and describe pain assessment in the hospitalized patient. 2. Discuss medications and interventional options for multimodal analgesia. 3. Explain pain management in the hospitalized patient who is obese or has a history of drug addiction.

  1. The transmission of acute pain sensations involves all of the following except
    1. peripheral and central nervous systems.
    2. complex regional pain syndrome activity.
    3. inhibitory and excitatory processes.
    4. neurotransmitters such as cytokines, glutamate, and substance P.
  2. Chronic pain syndrome involves three physiologic maladaptive processes, namely peripheral sensitization, central sensitization, and
    1. descending modulation of the pain stimulus.
    2. ascending sensitization of the pain stimulus.
    3. acute peripheral sensitization.
    4. inhibition of peripheral neurotransmitters.
  3. A clinically significant decrease in pain rating is defined as
    1. patient verbalization of feeling better.
    2. a numeric rating of 4 or below on the pain intensity rating scale.
    3. a 20% overall decrease in pain.
    4. a 30% overall decrease in pain.
  4. A recent survey of anesthesiologists revealed that non-opioid multimodal analgesia
    1. was a cause of patient dissatisfaction.
    2. was used by over 50% of anesthesiologists for postoperative pain.
    3. reduced opioid use by 46%.
    4. had no significant effect on postoperative nausea and vomiting.
  5. Non-opioid co-analgesics include all of the following except
    1. anticholinergics.
    2. antidepressants.
    3. antiepileptic medications.
    4. muscle relaxants.
  6. When given preoperatively, gabapentin
    1. provides an opioid-sparing effect of up to 60%.
    2. may interact with opioid analgesics.
    3. provides no significant difference in postoperative pain levels.
    4. is effective in reducing postoperative nausea and vomiting.
  7. Which statement is true about use of a fentanyl patch?
    1. It is not effective in treating cancer pain.
    2. It can take up to 8 hours for a patch to be effective.
    3. Patches are intended for opioid-tolerant patients.
    4. It is appropriate for treating pain levels of 4 to 6 on a 10-point scale.
  8. Which medication is not recommended for patients with acute pain?
    1. morphine
    2. hydrocodone
    3. fentanyl patches
    4. tramadol
  9. Patients using opioids should also be prescribed an antiemetic and
    1. antianxiety medication.
    2. antiepileptic medication.
    3. an anti-inflammatory.
    4. a laxative regimen.
  10. Which of the following is true about PCA therapy?
    1. PCA is inappropriate for most older adults.
    2. The most common opioids used for PCA are morphine, hydromorphone, or meperidine.
    3. PCA should be used with continuous pulse oximetry and capnography.
    4. Oversedation is not a risk with PCA.
  11. The recommended pain management technique following extensive surgery such as thoracotomy or a large abdominal surgery is
    1. epidural analgesia.
    2. PCA.
    3. I.bolus opioids.
    4. intraoperative blocks.
  12. Which pain management technique has shown high patient satisfaction for pain control and fewer opioid–related adverse reactions after joint replacement surgery?
    1. epidural analgesia
    2. peripheral local anesthetic catheter
    3. I.hydrocodone
    4. PCA
  13. Intraoperative nerve blocks typically last postoperatively for
    1. 6 to 8 hours.
    2. 10 to 12 hours.
    3. 14 to 16 hours.
    4. 18 to 24 hours.
  14. Which statement about acute abdominal pain is accurate?
    1. Pain medication reduces pain intensity and prevents full evaluation of the pain.
    2. Pain medication in the ED is contraindicated prior to diagnosis.
    3. Pain medication is unlikely to impair the sphincter of Oddi.
    4. Temporarily withholding pain medication can aid in diagnosing etiology of pain.
  15. Which statement about drug dependency or addiction is accurate?
    1. Older patients do not abuse pain medications.
    2. Dependency is a natural phenomenon occurring with regular use of an opioid.
    3. Addiction will occur in patients receiving daily opioids for more than 2 weeks.
    4. Dependency is characterized by a lack of control and compulsive drug use.
  16. Patients with pain who have a history of substance abuse should
    1. not be treated with intravenous opioids.
    2. not be given oral opioids in the hospital.
    3. be given less postoperative analgesia.
    4. be treated for pain via PCA.
  17. The major concern with the use of opioid analgesia in obese patients is
    1. hepatotoxicity.
    2. poor analgesic response.
    3. seizures.
    4. respiratory depression.


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