Medications
Which scheduled medication supports multimodal analgesia and reduces the need for opioids?
Acetaminophen (Tylenol) 650 mg every 6 hours.
Rationale: Scheduled Tylenol is a cornerstone of multimodal pain management for joint replacement recovery.
When should ketorolac be used instead of oxycodone?
When pain is mild to moderate and patient cannot tolerate PO medications
Rationale: Toradol IV provides non-opioid pain relief and is suitable when the oral route is not an option.
A patient reports nausea after receiving oxycodone. What nursing action is appropriate before calling for a new order?
Offer a small snack or crackers before next dose. If needed, administer anti-emetics.
Rationale: Taking opioids with food reduces GI irritation and nausea.
Zofran was given at 0446 but the patient continues to vomit. What’s your next step?
Administer Compazine as second-line antiemetic if ordered
Rationale: Compazine is typically used when Zofran is ineffective per post-op nausea orders.
What education would you give a patient about the purpose of combining Tylenol with oxycodone?
They work differently to control pain more effectively with fewer side effects.
Rationale: Using multiple mechanisms (multimodal approach) reduces opioid doses needed and improves comfort.
Your patient rates pain 3/10 but is about to start physical therapy. The oxycodone order is for moderate to severe pain. What should you do and document?
Give oxycodone and document in the MAR comment that it was given to premedicate for physical therapy. “Premedicated prior to physical therapy to maintain pain control.”
Rationale: Premedicating helps patients participate safely in therapy; documenting the rationale justifies giving outside the ordered parameters, ensures transparency and compliance with policy.
What is the risk of not premedicating a total joint patient before PT?
The patient may experience uncontrolled pain, limiting mobility and delaying recovery.
Rationale: Early mobility is critical; unmanaged pain can hinder progress and increase complications.
You gave oxycodone for “mild” pain rated 3/10 to keep pain manageable. What documentation supports this decision?
“Given to maintain consistent pain control; patient typically escalates with activity.”
Rationale: Preventive dosing maintains steady comfort and helps identify effective discharge dosing.
Why is it important to comment on the MAR when giving pain meds outside parameters?
It provides legal protection and clinical justification for the nursing decision.
Rationale: Clear documentation demonstrates sound judgment and adherence to policy.
A patient refuses Tylenol but requests oxycodone for mild pain. What should the nurse do first?
Educate on multimodal pain management and encourage use of Tylenol to reduce opioid needs.
Rationale: Tylenol enhances analgesia and reduces opioid consumption when used together.
After receiving oxycodone, your patient’s pain decreases from 8/10 to 5/10 but is still uncomfortable. What’s a non-pharmacological option to help manage pain?
Apply ice and elevate the extremity. Remember distraction is also a helpful tool! Even mobility can help.
Rationale: Non-pharmacologic interventions enhance comfort without additional medication.
What needs to be completed within 60 minutes of pain medication administration?
Pain reassessment and charted on EPIC.