shift is wild

Med-Surg · chapter 7 · Pain Assessment and Management

Pharmacological Pain Management

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

Skip to the questions ↓

Key points

  1. Analgesic administration principle

    When administering analgesics, start with the medication that has the fewest side effects, in the smallest dose possible, via the least invasive route.

  2. Nonopioid first choice

    Nonopioids should typically be the first choice to control pain, because they typically have fewer side effects than opioids and are less likely to result in addiction.

  3. Escalating pain regimen

    If pain persists or increases, then opioids may be added as additional therapies in combination with nonopioids and adjuvant therapies.

  4. Premedication before therapy

    To maximize the patient’s participation in physical therapy exercises, pharmacological pain management therapies may be administered thirty to sixty minutes before the therapy session.

  5. Acetaminophen maximum intake

    Older adults should take no more than 3,200 mg in a twenty-four-hour time frame, whereas healthy younger adults should take no more than 4,000 mg; patients with alcohol use disorder should take no more than 2,000 mg.

  6. Acetaminophen daily totals

    It is important to include all sources of acetaminophen in the daily totals, including amounts of the medication found in combination medications.

  7. Ketorolac older adults

    Use a reduced dose of ketorolac for patients aged 65 and older because of the risks of stomach or intestinal problems; swelling of the face, feet, or lower legs; and sudden decrease in urine production.

  8. NSAID gastrointestinal effects

    Side effects of NSAIDs can include dyspepsia, nausea, and vomiting. To reduce the risk of these side effects occurring, administer NSAIDs with food.

  9. Opioid pain treatment

    Opioids treat moderate to severe pain by blocking the release of neurotransmitters involved in sending pain signals.

  10. Serious opioid adverse effect

    Of the potential adverse effects of opioids, the most serious is respiratory depression. Monitor patients receiving opioids for decreased respiratory rate, oxygen saturation, and heart rate.

  11. Respiratory depression risk

    Patients at greatest risk for respiratory depression are those taking opioids for the first time, people receiving an increased dose of opioids, or individuals taking benzodiazepines or other sedatives, including alcohol, concurrently with opioids.

  12. PCA patient requirements

    PCAs may only be used for patients who are alert, oriented, and can independently press the button. Because small doses of opioids are administered frequently, it is important to monitor patients for oversedation and respiratory depression.

  13. PCA button safety

    To reduce the risk of these adverse events, the patient and all caregivers should understand that no one should press the PCA button except for the patient.

  14. Medication teaching basics

    The first time a medication is administered, the patient should be educated on the medication name, dose, route, and frequency at which they should take the medication.

Terms to know

pharmacological therapy
Therapy that involves drugs or medications is called pharmacological therapy.
analgesic
A pain medication may be classified as an analgesic, a medication used to prevent or treat pain, or an adjuvant, a medication that has an independent analgesic effect but also an additive analgesic property when administered with an opioid; an adjuvant is also called a coanalgesic.
adjuvant
A pain medication may be classified as an analgesic, a medication used to prevent or treat pain, or an adjuvant, a medication that has an independent analgesic effect but also an additive analgesic property when administered with an opioid; an adjuvant is also called a coanalgesic.
opioid
An opioid is a class of drugs derived from opium, a chemical sourced from poppy plants.
nonopioid
A nonopioid is a medication that is not an opioid.
ceiling effect
Morphine is commonly used for cancer and end-of-life pain because it is not associated with a ceiling effect, the point at which the effect of a drug plateaus, so that increasing the dose will not increase the effect.
patient-controlled analgesia (PCA)
The concept of patient-controlled analgesia (PCA) entails the patient self-administering opioid medications—including morphine, hydromorphone, and fentanyl—using a programmed pump.
Coanalgesics
Coanalgesics are medications that have analgesic effects but their primary indication is not pain relief.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. At 1900 shift change, you are receiving a patient who has a morphine PCA running. The outgoing nurse says the pump was checked earlier and the settings have not changed. What should happen before handoff documentation is complete?

    1. The outgoing nurse asks the patient to confirm that the PCA button works and documents patient understanding.
    2. The nurses wait to verify settings until the medication syringe is replaced.
    3. The incoming nurse reviews only the medication administration record and documents that the PCA was continued.
    4. Both nurses independently confirm the PCA pump settings, including the ordered drug, concentration, doses, and lockout interval.

    Answer: Both nurses independently confirm the PCA pump settings, including the ordered drug, concentration, doses, and lockout interval.

    The section states that both incoming and outgoing nurses should confirm PCA settings during shift change, with independent double-checking of key pump details. The other options rely on the MAR, the patient, or a later syringe change, none of which replaces the required shift-change confirmation.

  2. At 0815, you initiate a PCA and begin the required early reassessments. Which patient data belong in the typical PCA monitoring after the initial setup? Select all that apply.

    1. Ambulation distance
    2. Respiratory rate
    3. Alertness
    4. Oral intake
    5. Oxygen saturation
    6. Pain level

    Answer: Respiratory rate, Alertness, Oxygen saturation, Pain level

    The passage specifically lists pain level, alertness, respiratory rate, and oxygen saturation as typical monitoring data after PCA setup. Oral intake and ambulation distance may be documented in other contexts, but they are not listed here as part of the typical PCA monitoring sequence.

  3. At 1600, you are reviewing the MAR before giving Percocet 5/325 for pain. The patient also has acetaminophen 500 mg ordered for fever and received a dose earlier in the shift. What should guide your medication review before administration?

    1. Track the oxycodone component of Percocet, but do not include the acetaminophen component unless liver failure is documented.
    2. Give the Percocet as ordered and review the acetaminophen total only at the end of the shift.
    3. Count only the separate acetaminophen order toward the acetaminophen total because Percocet is documented as a pain medication.
    4. Recognize that both medications contain acetaminophen and consider the amount given in the four-to-six-hour window and the twenty-four-hour total.

    Answer: Recognize that both medications contain acetaminophen and consider the amount given in the four-to-six-hour window and the twenty-four-hour total.

    The correct response applies the section’s warning that combination medications such as Percocet contribute to the daily acetaminophen total. The other choices incorrectly separate combination medications from acetaminophen tracking or delay the review until after administration.

  4. At 2230, you reassess a patient after an opioid dose and are watching for possible opioid-induced respiratory depression. Which decreased findings would be relevant to document and report as warning signs? Select all that apply.

    1. Oxygen saturation
    2. Heart rate
    3. Itching
    4. Respiratory rate
    5. Nausea and vomiting

    Answer: Oxygen saturation, Heart rate, Respiratory rate

    The section identifies decreased respiratory rate, oxygen saturation, and heart rate as findings to monitor for respiratory depression. Itching and nausea/vomiting are opioid side effects discussed in the section, but they are not the listed signs of respiratory depression.

  5. At 0930, the physical therapist tells you the patient’s therapy session will begin at 1000 and asks whether the ordered PRN pain medication can be given to improve participation. Which timing best matches the section’s guidance?

    1. Hold the medication until after therapy so the patient can describe the full pain level during exercises.
    2. Schedule the medication for two hours before future sessions.
    3. Wait until the therapist arrives and administer the medication at the start of the session.
    4. Administer the ordered pain medication now, because the session is thirty minutes away.

    Answer: Administer the ordered pain medication now, because the session is thirty minutes away.

    The text states that pharmacological pain management may be given thirty to sixty minutes before therapy to allow time for effect. Giving it at the start, after therapy, or two hours before does not match the timing described.

  6. A patient using a PCA is drowsy but arousable. The patient’s spouse says, “If they fall asleep, I’ll press the button for them so the pain doesn’t get ahead.” What education should you provide?

    1. Tell the spouse to press the button only when the patient is asleep and appears uncomfortable.
    2. Allow the spouse to press the button if the lockout interval has passed.
    3. Explain that only the patient should press the PCA button.
    4. Instruct the spouse to ask the nurse to press the PCA button during hourly rounds.

    Answer: Explain that only the patient should press the PCA button.

    The PCA safety teaching in the section is that no one except the patient should press the button. The other options allow a caregiver or nurse to activate patient-controlled dosing, which conflicts with the stated education.

Where every quote comes from

Section 7.3 Pharmacological Pain Management of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.