TEST INSTRUCTIONS Read the article. The test for this CE activity is to be taken online at www.nursingcenter.com/CE/NP. Tests can no longer be mailed or faxed. You'll need to create (it's free!) and log in to your personal CE Planner account before taking online tests. Your planner will keep track of all your Lippincott Professional Development online CE activities for you. There's only one correct answer for each question. A passing score for this test is 8 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost. For questions, contact Lippincott Professional Development: 1-800-787-8985. Registration deadline is March 7, 2025. PROVIDER ACCREDITATION

Lippincott Professional Development will award 2.0 contact hours for this continuing nursing education activity.

Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, West Virginia, New Mexico, South Carolina, and Florida, CE Broker #50-1223. Your certificate is valid in all states.

Payment: The registration fee for this test is $21.95.

Pain management in primary care: A review of the updated CDC guideline

Learning Outcomes: Seventy-five percent of participants will be able to demonstrate knowledge about the updated CDC guideline for pain management in primary care by achieving a posttest score of 80% or greater.

Learning Objectives: After reading the article and completing the posttest, the participant will be able to:

Identify the barriers and risks associated with prescribing opioids and managing pain in the primary care setting. Apply guideline-supported opioid prescribing strategies recommended by the CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022. Recognize best practices endorsed by the CDC 2022 opioid guideline for initiating an opioid prescription for pain management.

Posttest: Questions #1-5 are knowledge-based questions.

According to data from the CDC, with a total of more than 142 million opioid prescriptions in 2020, the national opioid dispensing rate had fallen to its lowest rate in 15 years. had risen to the highest rate in 15 years. remained unchanged from the previous 15 years. Based on the recommendations in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain —United States, 2022, prescribing opioids should be avoided in patients with sickle cell disease. receiving end-of-life care. with moderate to severe sleep-disordered breathing. According to the 2021 National Survey on Drug Use and Health, the most common reason cited by patients for misuse of prescribed pain medications was for recreational purposes. diversion for profit. for relief of physical pain. Based on the 2022 CDC opioid guideline, clinicians should initially have a discussion regarding the potential benefits and risks of opioids before initiation of opioid therapy. only if they develop signs of opioid misuse or opioid use disorder. for the first time at a follow-up visit 6-8 weeks after initiation of opioid therapy. Patients are at a higher risk for opioid use disorder or overdose if they are taking an opioid dosage of up to 20 morphine milligram equivalent (MME) per day. have a history of depression or other mental health conditions. began short-term opioid therapy for acute pain and discontinued use after 6 days.Questions #6-10 are based on the following case scenario. Case Scenario:
J.S. arrives for a follow-up visit in the primary care office after being seen in the ED 2 days ago. You are the NP providing care for J.S. at his office visit. He is a 45-year-old male who had a chest wall contusion and non-displaced rib fractures due to a biking accident. The ED clinician prescribed an oral nonsteroidal anti-inflammatory drug (NSAID) for managing his pain. Since the ED visit, J.S. states that his pain has increased and limits his ability to take a deep breath. He states he is having difficulty performing some of his activities of daily living (ADLs) due to the high level of pain. He is opioid naive.
After weighing the risks and benefits, you decide to prescribe an opioid for acute pain management. An appropriate plan to initiate opioid pain management for J.S. is to prescribe long-acting opioids every 12 hours around the clock. immediate-release opioids at the lowest dose every 4 hours as needed for pain. immediate-release opioids at a high dose every 6 hours around the clock for 5 days. According to the 2022 CDC opioid guideline, before initiating a prescription for opioids for J.S., it is recommended that you contact his insurance company to see if a transdermal fentanyl patch will be covered. discontinue all other non-opioid pharmacologic therapies directed at pain management. check prescription drug monitoring program (PDMP) data. Following the 2022 CDC opioid guideline recommendations, in addition to J.S.'s initial opioid prescription, you also provide him with a prescription for naloxone. a benzodiazepine. a stool softener without a stimulant laxative. J.S. returns to the office 4 days later with increased rib pain, lethargy, and slurred speech. He admits to taking double the prescribed opioid dose this morning due to a high level of pain. Your next course of action should include switching to a long-acting opioid to better manage his acute pain. avoiding toxicology testing since J.S. is taking his opioids correctly as directed. initiating NSAIDs and lidocaine patches to be applied to his ribs, initiating a gradual taper of the opioid, and ordering physical therapy. Six months later, J.S. returns to the office. J.S. states he has been taking opioids for the past 6 months for managing his pain. You suspect he has opioid use disorder. The next appropriate action is to dismiss him from your practice. immediately discontinue his opioid use. refer him to a clinician knowledgeable in buprenorphine use.