What this area covers
Interns and residents in Australian hospitals manage ward calls, fluids, prescribing and deteriorating patients, often overnight. This page is for interns, residents and IMGs starting their first Australian hospital job, and focuses on safe, practical decisions.
High-yield topics
| Topic | What to know |
|---|---|
| Analgesia | Multimodal: paracetamol, NSAIDs, opioids |
| Opioid safety | Sedation scores, respiratory depression |
| Kidney disease | Avoid morphine accumulation |
| Delirium | Non-drug measures first |
| Withdrawal | Alcohol withdrawal protocols |
Worked example
Worked question · Opioids
An older patient on regular morphine is drowsy with RR 8. What is first?
- A Stop morphine; give naloxone
- B Increase morphine for pain
- C Give oral paracetamol only
- D Recheck observations in the morning
- E Add a benzodiazepine
Show the reasoning
Answer A. Opioid toxicity with respiratory depression needs stopping the opioid, airway support and titrated naloxone.
A short study plan
| Week | Focus |
|---|---|
| 1 | Core principles |
| 2 | Common ward calls |
| 3 | Timed questions and review |
Do a short timed set most days and review every explanation, including the options you ruled out.
Common traps
- Acting without checking local protocols.
- Delaying escalation.
- Poor documentation.
Free sample pain and sedation questions
Questions from our Junior Doctor bank. Choose your answer, then open the explanation.
Mrs Ho, 68, with obstructive sleep apnoea, is on an oxycodone PCA. She is hard to rouse with RR 9 and SpO₂ 87%. What is the immediate priority?
- ARecheck observations in 4 hours
- BStop the PCA, support airway and breathing
- CStart IV fluids at 150 mL/h
- DGive a sleeping tablet to settle her for the night
- EIncrease the PCA dose for pain
Show answer and explanation
Answer B. Sedation and respiratory depression on opioids need immediate action: stop the opioid, open the airway, give oxygen, call for help and give titrated naloxone. Sleep apnoea increases risk. What to do next: Give titrated naloxone, keep CPAP on when sleeping, review all sedating drugs, and increase monitoring.
Learning point: Opioid sedation: stop the opioid, support breathing, naloxone as needed.
Mrs Grant, 85, admitted with a fractured wrist, is agitated and pulling at her cannula at 1 am. She was orientated this afternoon. Observations are normal apart from HR 98. What is the most appropriate first action?
- AAsk the nurses to call you if she gets worse
- BPrescribe temazepam 10 mg to help her sleep
- CAssess for delirium and look for a cause
- DApply wrist restraints to protect the line
- EGive haloperidol 1 mg IM to sedate her
Show answer and explanation
Answer C. An acute change in behaviour in an older patient is delirium until proven otherwise. Assess (for example with the 4AT) and look for causes such as pain, urinary retention, constipation, infection, hypoxia and new medications. Use non-drug measures first; sedation is a last resort for safety. What to do next: Use the 4AT, check for retention, constipation, pain, hypoxia and new drugs, use non-drug strategies, and reserve low-dose antipsychotic for risk of harm after senior discussion.
Learning point: New confusion overnight in an older patient: assess for delirium and treat causes; avoid sedation if possible.
Mr Gill takes 60 mg of oral morphine a day. You want to switch him to oral oxycodone. What total daily dose of oxycodone is roughly equivalent?
- AAbout 60 mg
- BAbout 40 mg
- CAbout 20 mg
- DAbout 120 mg
- EAbout 90 mg
Show answer and explanation
Answer B. Oral oxycodone is about 1.5 times as potent as oral morphine, so 60 mg morphine is roughly 40 mg oxycodone a day. Many clinicians reduce the calculated dose further when switching opioids because of incomplete cross-tolerance, and check with a pharmacist. What to do next: Reduce the calculated equivalent dose by about 25–50% for incomplete cross-tolerance, prescribe breakthrough doses and check the conversion with a pharmacist.
Learning point: Oral morphine to oral oxycodone: divide by about 1.5.
Practise more pain and sedation questions free
Every pain and sedation subtopic in our bank
The bank holds 16 pain and sedation questions across 16 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Agitation at night1
- Antipsychotic dose in delirium1
- Benzodiazepines in withdrawal1
- Bowel care with opioids1
- Codeine1
- Desaturation on opioids1
- Gabapentinoids in older people1
- Itch from opioids1
- Morphine in kidney failure1
- Opioid conversion1
- Opioid toxicity1
- Pain1
- Paracetamol dosing1
- Paracetamol in low body weight1
- PRN orders1
- Tramadol cautions1
Common questions
Is this relevant to IMGs?
Yes. Australian hospital systems, protocols and escalation pathways may differ from your previous experience.
Should I follow local protocols?
Always. This page explains principles; local policies apply.
How many pain and sedation questions are in the Junior Doctor bank?
There are 16 pain and sedation questions across 16 subtopics, and the bank grows as new questions pass review.
Can I practise only pain and sedation questions?
Yes. Filter by area or by any subtopic to build a custom block, in tutor mode with explanations after each question or in timed mode.
How are pain and sedation questions explained?
Every question explains why the answer is right and why each other option is wrong, with a learning point and the Australian source behind it.
Which sources is this pain and sedation page based on?
It summarises current Australian guidance, including Therapeutic Guidelines; Australian Commission on Safety and Quality in Health Care. Guidelines change, so always check the latest edition.
When was this pain and sedation guide last updated?
It was last reviewed on 9 November 2026. We update topic pages when the exam or Australian guidance changes.
How do I unlock all Junior Doctor questions?
Choose a Junior Doctor plan: 3, 6 or 12 months of access, from A$139, one payment with no auto-renew. It opens every area, not just pain and sedation.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.