MDC 1 Exam 2 Study Guide
Rasmussen University (Latest
2026/2027 Update) Complete Q&A
with Verified Answers and Detailed
MDC 1 Exam 2 Study Guide Rasmussen | Comprehensive
Examination
MDC 1 Exam 2 Study Guide Rasmussen University (Latest
2026/2027 Update) Complete Q&A with Verified Answers and
Detailed Rationales Pain Management A+ Graded actual
INTRODUCTION
This document is an important and very helpful preparation
resource for MDC 1 Exam 2 Study Guide Rasmussen University
(Latest 2026/2027 Update) Complete Q&A with Verified
Answers and Detailed Rationales Pain Management A+
Graded. Every item uses a focused exam stem, four response
options, a keyed response, and a clear rationale, making it
easier to understand the subject, spot distractors, and build real
exam confidence.
Page 1
, Question 1
A patient with chronic cancer pain is receiving transdermal fentanyl 50 mcg/hr
and reports breakthrough pain 4-6 times daily. The provider orders
immediate-release morphine 15 mg PO q4h PRN. Which principle should
guide the nurse's evaluation of this regimen?
A. Transdermal fentanyl should be discontinued before initiating any
short-acting opioid to prevent cumulative respiratory depression.
B. The PRN morphine dose is likely inadequate because breakthrough
dosing should typically be 10-20% of the total 24-hour opioid
requirement.
C. Immediate-release morphine is contraindicated with transdermal
fentanyl due to CYP3A4 competitive inhibition.
D. The patient should be converted to a different long-acting opioid
before breakthrough dosing can be safely calculated.
Correct Answer: B - The PRN morphine dose is likely inadequate
because breakthrough dosing should typically be 10-20% of the
total 24-hour opioid requirement.
RATIONALE
Breakthrough pain dosing is generally 10-20% of the total daily
long-acting opioid dose; a 50 mcg/hr fentanyl patch approximates 120
mg oral morphine equivalents daily, so 15 mg PRN is subtherapeutic.
Option A is incorrect because short-acting opioids are routinely used
alongside transdermal fentanyl for breakthrough pain. Option C is
incorrect; morphine is primarily glucuronidated, and clinically
significant CYP3A4 interaction is not the primary concern. Option D
is unnecessary before establishing appropriate breakthrough dosing.
Question 2
A patient is prescribed ketorolac 30 mg IV q6h for postoperative pain. Which
assessment finding most urgently requires the nurse to hold the medication and
notify the provider?
Page 2
, A. Serum creatinine increased from 0.9 to 1.6 mg/dL over 48 hours
B. Reported pain intensity decreased from 8/10 to 5/10 after the first dose
C. Capillary refill of 3 seconds and blood pressure 118/72 mm Hg
D. Patient reports mild nausea without vomiting after the second dose
Correct Answer: A - Serum creatinine increased from 0.9 to 1.6
mg/dL over 48 hours
RATIONALE
Ketorolac is a nonselective NSAID that reduces renal prostaglandins
and can precipitate acute kidney injury; a rise in creatinine from 0.9 to
1.6 mg/dL signals declining renal function and warrants holding the
drug. Option B reflects expected analgesic effect. Option C is a normal
finding. Option D is a common, non-urgent adverse effect that does
not require holding the medication.
Question 3
A patient with a history of opioid use disorder is admitted with acute
pancreatitis and severe pain. The provider is reluctant to order opioids. Which
nursing action best reflects current best practice for equitable pain
management?
A. Advocate for a multimodal analgesic plan that includes opioid agonists
with clear functional goals and close monitoring rather than withholding
opioids.
B. Support the provider's plan to use only non-opioid adjuvants because
opioids are contraindicated in opioid use disorder.
C. Request that the patient be placed on a formal behavioral contract
before any analgesic is administered.
D. Recommend that pain be managed primarily with benzodiazepines to
avoid opioid receptor stimulation.
Correct Answer: A - Advocate for a multimodal analgesic plan
that includes opioid agonists with clear functional goals and close
monitoring rather than withholding opioids.
Page 3
, RATIONALE
Current best practice (CDC 2022, AHRQ) supports treating acute pain
in patients with opioid use disorder using multimodal analgesia that
may include opioids with clear goals, monitoring, and
non-stigmatizing care. Option B is incorrect because opioids are not
absolutely contraindicated in opioid use disorder when clinically
indicated for acute severe pain. Option C reflects outdated,
stigmatizing practice. Option D is unsafe because benzodiazepines do
not treat pain and increase respiratory depression risk.
Question 4
A patient is receiving intravenous patient-controlled analgesia (PCA) with
morphine. The nurse notes the patient is sedated but arousable and has a
respiratory rate of 10/min. Which action is most appropriate?
A. Continue the PCA and reassess in 30 minutes, as these findings are
expected with opioid therapy.
B. Hold the PCA, perform a thorough sedation and respiratory
assessment, and consider reducing the dose per protocol.
C. Administer naloxone 0.4 mg IV push immediately to reverse sedation.
D. Increase the PCA demand dose to improve pain control while
monitoring sedation.
Correct Answer: B - Hold the PCA, perform a thorough sedation
and respiratory assessment, and consider reducing the dose per
protocol.
RATIONALE
Sedation often precedes respiratory depression; a sedation score
indicating the patient is only arousable with a respiratory rate of
10/min warrants holding the PCA, thorough assessment, and possible
dose reduction per protocol. Option A is unsafe because early
respiratory depression can progress. Option C is excessive; naloxone
is reserved for significant respiratory depression and should be
titrated. Option D would worsen sedation and respiratory status.
Page 4
Rasmussen University (Latest
2026/2027 Update) Complete Q&A
with Verified Answers and Detailed
MDC 1 Exam 2 Study Guide Rasmussen | Comprehensive
Examination
MDC 1 Exam 2 Study Guide Rasmussen University (Latest
2026/2027 Update) Complete Q&A with Verified Answers and
Detailed Rationales Pain Management A+ Graded actual
INTRODUCTION
This document is an important and very helpful preparation
resource for MDC 1 Exam 2 Study Guide Rasmussen University
(Latest 2026/2027 Update) Complete Q&A with Verified
Answers and Detailed Rationales Pain Management A+
Graded. Every item uses a focused exam stem, four response
options, a keyed response, and a clear rationale, making it
easier to understand the subject, spot distractors, and build real
exam confidence.
Page 1
, Question 1
A patient with chronic cancer pain is receiving transdermal fentanyl 50 mcg/hr
and reports breakthrough pain 4-6 times daily. The provider orders
immediate-release morphine 15 mg PO q4h PRN. Which principle should
guide the nurse's evaluation of this regimen?
A. Transdermal fentanyl should be discontinued before initiating any
short-acting opioid to prevent cumulative respiratory depression.
B. The PRN morphine dose is likely inadequate because breakthrough
dosing should typically be 10-20% of the total 24-hour opioid
requirement.
C. Immediate-release morphine is contraindicated with transdermal
fentanyl due to CYP3A4 competitive inhibition.
D. The patient should be converted to a different long-acting opioid
before breakthrough dosing can be safely calculated.
Correct Answer: B - The PRN morphine dose is likely inadequate
because breakthrough dosing should typically be 10-20% of the
total 24-hour opioid requirement.
RATIONALE
Breakthrough pain dosing is generally 10-20% of the total daily
long-acting opioid dose; a 50 mcg/hr fentanyl patch approximates 120
mg oral morphine equivalents daily, so 15 mg PRN is subtherapeutic.
Option A is incorrect because short-acting opioids are routinely used
alongside transdermal fentanyl for breakthrough pain. Option C is
incorrect; morphine is primarily glucuronidated, and clinically
significant CYP3A4 interaction is not the primary concern. Option D
is unnecessary before establishing appropriate breakthrough dosing.
Question 2
A patient is prescribed ketorolac 30 mg IV q6h for postoperative pain. Which
assessment finding most urgently requires the nurse to hold the medication and
notify the provider?
Page 2
, A. Serum creatinine increased from 0.9 to 1.6 mg/dL over 48 hours
B. Reported pain intensity decreased from 8/10 to 5/10 after the first dose
C. Capillary refill of 3 seconds and blood pressure 118/72 mm Hg
D. Patient reports mild nausea without vomiting after the second dose
Correct Answer: A - Serum creatinine increased from 0.9 to 1.6
mg/dL over 48 hours
RATIONALE
Ketorolac is a nonselective NSAID that reduces renal prostaglandins
and can precipitate acute kidney injury; a rise in creatinine from 0.9 to
1.6 mg/dL signals declining renal function and warrants holding the
drug. Option B reflects expected analgesic effect. Option C is a normal
finding. Option D is a common, non-urgent adverse effect that does
not require holding the medication.
Question 3
A patient with a history of opioid use disorder is admitted with acute
pancreatitis and severe pain. The provider is reluctant to order opioids. Which
nursing action best reflects current best practice for equitable pain
management?
A. Advocate for a multimodal analgesic plan that includes opioid agonists
with clear functional goals and close monitoring rather than withholding
opioids.
B. Support the provider's plan to use only non-opioid adjuvants because
opioids are contraindicated in opioid use disorder.
C. Request that the patient be placed on a formal behavioral contract
before any analgesic is administered.
D. Recommend that pain be managed primarily with benzodiazepines to
avoid opioid receptor stimulation.
Correct Answer: A - Advocate for a multimodal analgesic plan
that includes opioid agonists with clear functional goals and close
monitoring rather than withholding opioids.
Page 3
, RATIONALE
Current best practice (CDC 2022, AHRQ) supports treating acute pain
in patients with opioid use disorder using multimodal analgesia that
may include opioids with clear goals, monitoring, and
non-stigmatizing care. Option B is incorrect because opioids are not
absolutely contraindicated in opioid use disorder when clinically
indicated for acute severe pain. Option C reflects outdated,
stigmatizing practice. Option D is unsafe because benzodiazepines do
not treat pain and increase respiratory depression risk.
Question 4
A patient is receiving intravenous patient-controlled analgesia (PCA) with
morphine. The nurse notes the patient is sedated but arousable and has a
respiratory rate of 10/min. Which action is most appropriate?
A. Continue the PCA and reassess in 30 minutes, as these findings are
expected with opioid therapy.
B. Hold the PCA, perform a thorough sedation and respiratory
assessment, and consider reducing the dose per protocol.
C. Administer naloxone 0.4 mg IV push immediately to reverse sedation.
D. Increase the PCA demand dose to improve pain control while
monitoring sedation.
Correct Answer: B - Hold the PCA, perform a thorough sedation
and respiratory assessment, and consider reducing the dose per
protocol.
RATIONALE
Sedation often precedes respiratory depression; a sedation score
indicating the patient is only arousable with a respiratory rate of
10/min warrants holding the PCA, thorough assessment, and possible
dose reduction per protocol. Option A is unsafe because early
respiratory depression can progress. Option C is excessive; naloxone
is reserved for significant respiratory depression and should be
titrated. Option D would worsen sedation and respiratory status.
Page 4
