Pain Management in Nursing - 3105

9 -11 questions

A patient steps on a nail, and nociceptors in the foot immediately fire, generating an electrical signal. Which step of nociception does this represent?
A. Transmission
B. Modulation
C. Transduction
D. Perception

Answer: C
Rationale: Transduction is when a painful stimulus is converted into a nerve impulse at the injury site.

Following tissue injury, which substances increase pain sensitivity and cause vasodilation?
A. Serotonin and dopamine
B. Histamine, substance P, bradykinin, prostaglandins
C. Acetylcholine and norepinephrine
D. GABA and endorphins

Answer: B
Rationale: These inflammatory mediators increase nociceptor sensitivity and promote swelling and pain.

A nurse applies a TENS unit for chronic pain. Which theory explains its effect?
A. Nociception theory
B. Gate control theory
C. Modulation theory
D. Perception theory

Answer: B
Rationale: Non-painful stimuli can block pain signals at the spinal cord, “closing the gate.”

What does modulation refer to in nociception?
A. Activation of receptors
B. Signal transmission
C. Pain awareness
D. Inhibition of pain signals

Answer: D
Rationale: Modulation reduces pain through endogenous opioids like endorphins.

Which findings indicate mild-to-moderate pain?
A. Decreased HR and BP
B. Increased HR, BP, diaphoresis
C. Bradycardia and hypotension
D. No changes

Answer: B
Rationale: Mild pain activates the sympathetic nervous system.

A patient with severe abdominal pain has HR 52 and BP 88/54. What explains this?
A. Sympathetic response
B. Parasympathetic response
C. Medication effect
D. Cardiac issue

Answer: B
Rationale: Severe visceral pain can trigger vagal (parasympathetic) response causing bradycardia and hypotension.

A patient has intermittent sickle cell pain crises. What type of pain is this?
A. Acute
B. Chronic
C. Chronic episodic
D. Neuropathic

Answer: C
Rationale: Pain occurs in episodes with periods of relief.

A diabetic patient reports burning, shooting foot pain. What type is this?
A. Somatic
B. Visceral
C. Neuropathic
D. Referred

Answer: C
Rationale: Neuropathic pain is caused by nerve damage and feels burning or tingling.

SATA Which statements about pain are correct?
A. Somatic pain is aching
B. Neuropathic pain is burning
C. Visceral pain may cause nausea
D. Neuropathic pain always has injury
E. Cancer pain can be mixed
F. Referred pain occurs elsewhere

Answer: A, B, C, E, F
Rationale: Neuropathic pain may not have a clear injury; all others are correct characteristics.

A post-surgical patient has predictable pain that resolves with healing. What type is this?
A. Chronic
B. Neuropathic
C. Acute
D. Episodic

Answer: C
Rationale: Acute pain is short-term with a clear cause and resolution.

A patient refuses pain medication due to cultural beliefs about stoicism. What factor is influencing this behavior?

 A. Physiological tolerance

 B. Cultural beliefs and values

 C. Psychological disorder

 D. Poor assessment

Answer: B

 Rationale: Culture affects how patients express pain and whether they seek treatment.

A patient with chronic pain reports poor sleep, depression, and inability to do daily activities. What does this illustrate?

 A. Drug-seeking behavior
 B. Multidimensional impact of chronic pain

 C. Malingering

 D. Normal adaptation

Answer: B

 Rationale: Chronic pain affects physical, emotional, and functional well-being.

A patient states, “Pain gets worse when I walk and better when I sit.” Which PQRST component is this?

 A. Quality

 B. Region

 C. Severity

 D. Provocation/Palliation

Answer: D
Rationale: This describes what worsens or relieves pain.

Which pain tool is best for a 4-year-old after surgery?
A. Numeric scale
B. PAINAD
C. CPOT
D. FLACC

Answer: D

 Rationale: FLACC is used for young children who cannot self-report.

Which pain tool is best for a patient with severe dementia?

 A. Numeric scale
 B. FACES scale
 C. PAINAD

 D. FLACC

Answer: C

 Rationale: PAINAD assesses pain in patients with cognitive impairment.

A ventilated ICU patient shows grimacing and rigidity. Which tool should be used?

 A. Numeric scale

 B. FLACC

 C. CPOT

 D. PAINAD

Answer: C

 Rationale: CPOT is used for critically ill patients unable to communicate.

SATA Which are correct pain assessment principles?

 A. Pain is subjective
B. Vital signs alone are enough

C. Sleeping means no pain

D. Use appropriate scale
E. Assess impact on life
F. Reassess after intervention

Answer: A, D, E, F

 Rationale: Pain is subjective, requires proper tools, affects function, and must be reassessed.

Before giving IV morphine, what is MOST important to assess?

 A. Pain score only

 B. Full safety assessment (RR, sedation, O2, pain)

 C. Call provider
 D. Addiction history

Answer: B

 Rationale: Opioid safety requires respiratory and sedation assessment before administration.

Which statement about opioids is correct?

 A. Only for acute pain

 B. Constipation resolves over time
 C. They cause multiple side effects including respiratory depression

 D. Start with highest dose

Answer: C

 Rationale: Opioids commonly cause sedation, constipation, and respiratory depression.

A patient has RR 8 and is difficult to arouse after morphine. What is the PRIORITY action?

 A. Reassess pain

 B. Give more morphine

 C. Stimulate, give oxygen, prepare naloxone

 D. Change position

Answer: C

 Rationale: This is opioid-induced respiratory depression and requires immediate intervention.

21. A patient on morphine PCA is sleeping but easily aroused, RR 14, SpO₂ 96%. How is this classified on the POSS scale?
    

A. Level 4

B. Level 3

C. Acceptable (S or 1–2)

D. Requires dose increase

Answer: C

Rationale: Easily aroused with stable vitals is acceptable sedation.

22. A patient on opioids is difficult to arouse and has RR 6. What is the FIRST action?
    

A. Document

B. Stop opioid and give oxygen, prepare naloxone

C. Reassess later

D. Decrease dose

Answer: B

Rationale: This is respiratory depression; airway and breathing are priority.

23. SATA Which teaching points are correct for opioid use?
    

A. Avoid driving

B. Manage constipation

C. Double missed doses

D. Report breathing issues

E. Store safely

F. Prescribed use ≠ addiction

Answer: A, B, D, E, F

Rationale: Safe use includes preventing sedation risks, managing constipation, and proper storage; never double doses.

24. Before giving acetaminophen, what is MOST important?
    

A. Give immediately

B. Check total daily dose

C. Switch to NSAID

D. Ignore combination meds

Answer: B

Rationale: Excess acetaminophen can cause liver toxicity.

25. Why is duloxetine prescribed for neuropathic pain?
    

A. Treats depression only

B. Works on nerve pathways

C. Prevents opioid use

D. Has no pain effect

Answer: B

Rationale: It acts on neurotransmitters to reduce nerve pain.

26. Family asks to press PCA button. What is the BEST response?
    

A. It’s fine

B. Use judgment

C. Only patient should press it

D. Give extra medication

Answer: C

Rationale: PCA safety relies on patient-controlled dosing.

27. What is naloxone?

A. Opioid enhancer

B. Opioid blocker

C. Long-term prevention

D. Delayed treatment

Answer: B

Rationale: Naloxone reverses opioid effects by blocking receptors.

28. After naloxone, patient reports severe pain. What is PRIORITY?
    

A. Give opioid

B. Monitor closely
C. Ignore pain

D. Stop opioids permanently

Answer: B

Rationale: Naloxone wears off quickly; respiratory depression can return.

29. Which opioid finding is MOST concerning?

A. Pain reduced

B. Mild nausea

C. RR 8, hard to arouse

D. Sleeping easily aroused

Answer: C

Rationale: Respiratory depression is life-threatening.

30. SATA Which opioid facts are correct?
    

A. Respiratory depression is most serious

B. Constipation resolves

C. Use sedation scale

D. Nausea is common

E. Naloxone reverses opioids

F. Start low, go slow

Answer: A, C, D, E, F

Rationale: Constipation does NOT resolve; all others are correct.

31. Why does heat therapy reduce pain?
    

A. Blocks prostaglandins

B. Activates gate control

C. Acts as opioid

D. Reduces inflammation

Answer: B

Rationale: Stimulates non-pain fibers to block pain signals.

32. Best nonpharmacological pain plan?
    

A. No activity

B. Combine therapies with meds

C. Avoid all meds

D. Use only if meds unavailable

Answer: B

Rationale: Multimodal approach is most effective.

33. Nurse hesitates to give opioids to patient with addiction history. What is correct?
    

A. Withhold meds

B. Change order

C. Give as prescribed

D. Make patient prove pain

Answer: C

Rationale: Pain is subjective; all patients deserve treatment.

34. Patient fears addiction. Best response?
    

A. Ignore concern

B. Educate about proper use

C. Cultural issue

D. Withhold meds

Answer: B

Rationale: Education reduces fear and improves pain management.

35. Parent says infants don’t feel pain. Best response?
    

A. True
B. Infants feel pain
C. Same as adults
D. Not treated

Answer: B

Rationale: Infants have functional pain pathways and need treatment.

36. Older adult reports low pain but avoids meds. What is MOST important?
    

A. Accept report
B. Assess function and underreporting
C. Increase pain score
D. Reduce meds

Answer: B

Rationale: Older adults often underreport pain; assess impact.

After morphine, pain drops from 8 to 4 and patient is comfortable. What does this mean?

A. Ineffective
B. Effective
C. Give more meds
D. Done assessing

Answer: B

Rationale: Pain reduction with improved function = effective.

Which outcome shows effective chronic pain management?

A. Pain 0/10 always
B. Improved function and lower pain
C. Max meds used
D. Stop meds complete

Answer: B

Rationale: Success is improved quality of life and function, not zero pain.