NURS 565 WEEK 2 REVISED PRACTICE GUIDE EXAM 2026

NURS 565 WEEK 2 REVISED PRACTICE GUIDE EXAM 2026 Types of Acute Pain - - -Referred Pain • Pain that is present in an area removed or distant from its point of origin -Acute Somatic Pain • Arises from connective tissue, muscle, bone & skin • Sharp & localized or dull & non-localized • Responds best to: acetaminophen, corticosteroids, NSAIDs, opiates, local anesthetics, ice, massage -Acute visceral pain • Pain in the internal organs & abdomen • Poorly localized (C-fibers) • Radiates • Most responsive to opiates • May also use corticosteroids, NSAIDs *rated by severity Inflammatory response - --inflammation • redness • swelling • heat • pain Chemokines - -small proteins cells release as a signaling mechanism -best known for their ability to stimulate the migration of cells, most notably white blood cells (leukocytes). mast cells - --release histamine • goes to endothelial cells that line capillaries, makes capillaries larger (vasodilation), causing swelling, capillary walls become more porous (things get through more easily) First responders - -phagocytes Neutrophils Diapedesis - -the passage of blood cells through the intact walls of the capillaries, typically accompanying inflammation. Extravasation - -escape of fluid from a blood vessel into surrounding tissue NURS 565 NURS 565 Pain is influenced by: - -gender, genetics, social, cultural, and personal factors Acute pain has an occurrence of fewer than __________ - -three months -often precipitated by trauma & acute medical conditions or tx Treatment goals about pain relief: Considerations - --reducing the intensity of pain while enhancing physical & psychological functioning -common goal is to resume the activities of daily life -Complete elimination of pain is often not realistic if the source of pain continues to exist • finding the lowest effective dose to achieve tolerable pain levels is paramount -Non-pharmacological treatments may also be considered to promote comfort Appropriate selection of medications includes: - --Patient factors • age, ethnicity, gender, the presence of hepatic and/or renal impairment, genetic polymorphisms, and/or coexisting cardiorespiratory or cerebrovascular disease -Drug factors • Drug metabolism, receptor binding strength, potential for drug-drug interactions, and/or co-administration with other CNS depressants Commonly used agents for acute pain management - --Opioids -Acetaminophen -NSAIDs -Salicylates -COX-2 Inhibitors Opioids - --Drug Indication: • Moderate to severe pain -Dosing Considerations: • Opioid naïve vs chronic pain patient -Adverse Drug Reactions: • Sedation, drowsiness, mental clouding; constipation; nausea & decreased appetite; sexual dysfunction; tolerance/ dependency • ADRs worse when combined with alcohol or benzodiazepines -Patient Education: • Clear instructions regarding safety & ADRs • discuss length of tx; discuss non-opiate therapy -Monitoring: • Is pain medication effective? Is the dose being tapered or discontinued? If not reassess cause of pain. -Drug Interaction: • Any other drug that causes a sedative effect. Acetaminophen - --Drug Indication: • Mild to moderate pain -Dosing Considerations: Dose appropriately NURS 565 NURS 565 • Mild pain: 325 to 650 mg q4-6 hrs • Children: 10/kg/mg every 4 to 8 hours • Moderate pain: 500 to 1,000 mg q4-6 hrs drugging indication used for fever • Max: 4 gms/ 24 hrs use for fever &/or pain • Children: 15 mg/kg/dose -Adverse Drug Reactions: • Usually well-tolerated • Hepatic injury with overdose • Renal disease with chronic use -Drug interactions: • alcohol -Patient Education: • Do not exceed maximum dose (4gm/24 hours) -Monitoring: • Monitor for effectiveness. May need to add an opioid agonist -Drug Interaction: • None NSAIDS - --Drug Indication: • Use for fever &/or pain • inflammation as an antiplatelet -Avoid in pregnancy & renal dysfunction -Dosing Considerations: -Ibuprofen dosing: • 200-800 mg/ dose every 6-8 hrs • Maximum: 3,200 mg/day • Children: 5 to 10 mg/kg/dose (Pediatric dosage maximum is 40mg/kg/day) -Naproxen dosing: • 500mg Then 500mg every 12 hours or 250mg every 6-8 hrs • Maximum: 1,250 mg/day •-Adverse Drug Reactions: • Gastrointestinal (GI) upset, dyspepsia, abdominal pain, GI bleed, fluid retention, edema, hypertension, renal damage Salicylates - --Drug Indication: • Use for fever, pain, inflammation, antiplatelet use. -Avoid in pregnancy, children, & renal dysfunction. -Dosing Considerations: • Dosing for pain: 325 mg to 1,000 mg q4-6 hrs (max: 4 gm/day) • Arthritis: 3.6 to 5.4 gm/day in divided doses -Adverse Drug Reactions: • GI upset, dyspepsia, abdominal pain, GI bleed, renal impairment, tinnitus -Monitoring: • Monitor for effectiveness. May need to add an opioid agonist COX-2 Inhibitors - --Drug Indication: NURS 565 NURS 565 • Use for pain &/or inflammation. -Avoid in pregnancy, children, renal dysfunction, pain after coronary artery bypass graft surgery, use caution in heart failure, hypertension, & fluid retention -Dosing Considerations: • pts with renal impairment & cardiovascular disease -Adverse Drug Reactions: • GI upset, abdominal pain, GI bleed, edema, HTN, thrombi events (myocardial infarction & stroke), fluid retention, renal impairment, poor metabolizers of CYP2C9 -Patient Education: • Avoid alcohol use. • Avoid aspirin & OTC medications. • May increase risk of myocardial infarction or stroke -Monitoring: • Monitor for effectiveness. May need to add an opioid agonist. -Drug Interaction: • Drugs that inhibit CYP2C9, drugs that are metabolized by CYP2D6, increased risk of renal failure with angiotensin-converting enzyme inhibitors Chronic Pain Management - -Pain that persists beyond three months or the expected time of healing is chronic -Agents used to manage are often the same ones used to manage acute pain Special Considerations in Opioid Medication Management - --An opioid is an agent that works at an opioid receptor, is a derivative from opium -includes full agonists, partial agonists, mixed agonist-antagonists, and antagonists -Opioids have a variable affinity for certain receptors -absorption and therapeutic effects are impacted by the route and individual characteristics. -Short-acting opioids should be used exclusively for the treatment of acute pain in opioid naïve patients -Titration to optimal therapeutic effects is faster, safer, and easier with immediate release opioids -Unintentional overdose may be more likely when opioid therapy begins with long-acting opioids in opioid naïve patients. Guidelines in Opioid Prescribing - --three main principles to improve opioid prescribing • determining when to initiate or continue opioids for chronic pain • opioid selection, dosage, duration, follow-up, & discontinuation • assessing risk & addressing harms of opioid use Conversion of opioid analgesia formulations - --requires extreme caution & consideration of the unique characteristics of the patient -Use of conversion calculators • requires consideration of the specific patient characteristics & variability -Referral to a pain specialist is required for pts who take 120mg/day of morphine milligram equivalents NURS 565 NURS 565 12 essential considerations for safe pain management - - 1. Opioids are not first-line therapy 2. Establish goals for pain & function 3. Discuss risk & benefits 4. Use IR opioids when starting 5. Use the lowest effective dose 6. Prescribe short durations for acute pain 7. Evaluate benefits & harms frequently 8. Use strategies to mitigate risk 9. Review PDMP data 10. Use urine drug testing 11. Avoid concurrent opioid & benzodiazepine prescribing 12. Offer tx for opioid disorder Opioid Use Disorder - --2017, federal gov declared the opioid crisis a national emergency -DSM-IV describes opioid use disorder as a pattern of use that leads to significant impairment or distress • Typically marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school, or home responsibilities Opioid use - --Opioid use creates high levels of positive reinforcement, increasing the likelihood of continued use -often a chronic lifelong disorder -serious consequences such as disability and death -can lead to physical dependence in only 4-8 weeks Opioid use disorder can lead to: - -severe withdrawal symptoms, uncontrolled pain, as well as psychological distress, and suicidal ideation Risk Evaluation and Mitigation Strategy (REMS) & Naloxone - --REMS • drug safety program to reinforce safe medication use • issued by the U.S. Food and Drug Administration (FDA) • Goals: ensure that medication is used according to FDA-approved prescribing & that the benefits outweigh the risk of misuse & abuse -FDA requires drug manufacturers to add recommendations about naloxone to prescribing information • used to quickly reverse an opioid overdose Preventing Opioid Overdose Deaths - --Substance Abuse and Mental Health Service Administration (SAMHSA) identifies five strategies to prevent overdose deaths: • encourage providers, persons at high risk, their family members, & others to learn how to prevent & manage opioid overdose • ensure access to tx for individuals who are misusing opioids or have a SUD • ensure ready access to naloxone