A patient in the intensive care unit is sedated and receiving mechanical ventilation, so they cannot self-report discomfort. Which tool is designed to assess this patient's pain?
Critical-Care Pain Observation Tool
✓
Numeric rating scale
Wong-Baker FACES scale
Verbal descriptor scale
Correct Answer
Critical-Care Pain Observation Tool
The Critical-Care Pain Observation Tool scores what the nurse can observe in a critically ill patient who cannot communicate, such as facial expression, body movement, muscle tension, and how well the patient tolerates the ventilator. A numeric rating scale requires the patient to choose a number, which a sedated, intubated patient cannot do. The Wong-Baker FACES scale requires the patient to point to a face that matches the pain. A verbal descriptor scale requires the patient to pick words such as mild or severe, which also depends on self-report.
Category: Choosing a Pain Tool
Question 2
A resident of a memory care unit has advanced Alzheimer disease and can no longer describe sensations. Which tool fits this patient's pain assessment?
Numeric rating scale
PAINAD scale
✓
Visual analog scale
McGill Pain Questionnaire
Correct Answer
PAINAD scale
The PAINAD scale (Pain Assessment in Advanced Dementia) relies on observed breathing, negative vocalization, facial expression, body language, and consolability, so it does not depend on the patient's own rating. A numeric rating scale requires the patient to understand and choose a number. A visual analog scale requires the patient to mark a point on a line, which needs comprehension. The McGill Pain Questionnaire asks the patient to choose descriptive words, which a patient with advanced dementia cannot reliably do.
Category: Choosing a Pain Tool
Question 3
A toddler admitted with a forearm fracture is too young to describe or rate discomfort. Which tool should the nurse use to assess the child's pain?
Numeric rating scale
PAINAD scale
FLACC scale
✓
McGill Pain Questionnaire
Correct Answer
FLACC scale
The FLACC scale scores face, legs, activity, cry, and consolability, so the nurse can rate pain in infants and young children who cannot yet self-report. A numeric rating scale requires a child old enough to understand numbers. The PAINAD scale was developed for adults with advanced dementia. The McGill Pain Questionnaire requires the patient to choose words that describe the pain.
Category: Choosing a Pain Tool
Question 4
A patient with long-standing osteoarthritis rates their pain as severe, but their pulse, respirations, and blood pressure are within their usual range. How should the nurse interpret these findings?
Normal vital signs show the pain is milder than the patient reports
The patient is likely exaggerating to obtain more medication
Pain cannot be treated until the vital signs become elevated
Chronic pain often causes no vital sign changes, so the report is accepted
✓
Correct Answer
Chronic pain often causes no vital sign changes, so the report is accepted
With chronic pain the body adapts to the ongoing stimulus, so pulse, respirations, and blood pressure often stay at baseline even when pain is severe; the patient's self-report remains the basis for treatment. Saying normal vital signs show the pain is milder than reported ignores this adaptation. Assuming the patient is likely exaggerating to obtain more medication is a bias that leads to undertreatment. Waiting until vital signs become elevated would leave real pain untreated.
Category: Pain Assessment Skills
Question 5
On the first day after abdominal surgery, a patient says the goal is to feel no pain at all. What is the nurse's best response?
Work with the patient to set a realistic goal that allows rest and activity
✓
Agree that complete relief is the target and give every available analgesic
Tell the patient that goals are set by the surgeon, not by patients
Skip goal setting, because goals do not apply after surgery
Correct Answer
Work with the patient to set a realistic goal that allows rest and activity
A pain goal is set together with the patient on the same scale used for assessment, and complete absence of pain is often unrealistic after surgery; a useful goal lets the patient rest, breathe deeply, and move. Agreeing that complete relief is the target and giving every available analgesic raises the risk of oversedation. Telling the patient that goals are set by the surgeon ignores the patient's role in planning care. Skipping goal setting removes the measure the nurse uses to judge whether interventions worked.
Category: Pain Assessment Skills
Question 6
Which question by the nurse is most likely to give a full description of a patient's pain?
"Is the pain sharp?"
"Can you describe what the pain feels like to you?"
✓
"Does the pain stay in one place?"
"Is the pain worse than yesterday?"
Correct Answer
"Can you describe what the pain feels like to you?"
An open-ended request lets the patient describe the pain in their own words, which reveals its quality, spread, and effect on daily life. Asking whether the pain is sharp invites a yes or no answer and suggests a description to the patient. Asking whether the pain stays in one place also invites a one-word answer. Asking whether it is worse than yesterday compares intensity but leaves out the pain's character and pattern.
Category: Pain Assessment Skills
Question 7
An older adult who is grimacing and guarding a hip tells the nurse, "I'm fine, this is just what happens when you get old." Which factor most likely explains this response?
A higher pain threshold that develops with age
A loss of all nerve endings in the hip joint
A belief that pain is a normal part of aging
✓
An inability to feel pain once a person is older
Correct Answer
A belief that pain is a normal part of aging
Older adults are more likely than younger adults to have pain but less likely to report it, often because they believe pain is expected with age; the nurse should look for physical cues and assess further. A higher pain threshold that develops with age does not explain a patient who is visibly grimacing and guarding. A loss of all nerve endings in the hip joint does not occur with aging. An inability to feel pain once a person is older is false, and the grimacing and guarding show the patient does feel it.
Category: Special Populations
Question 8
A patient has diabetic neuropathy with burning pain in both feet. Which safety risk should the nurse address in teaching?
Bleeding from fragile blood vessels in the feet
Fractures from sudden loss of bone density
Infection spread through the bloodstream to the brain
Burns from not sensing hot water or surfaces
✓
Correct Answer
Burns from not sensing hot water or surfaces
Neuropathic pain comes from nerve damage, and the same damage can dull the ability to sense heat and cold, so the patient may not notice a burn; teaching includes checking bath water with a thermometer and inspecting the feet daily. Bleeding from fragile blood vessels in the feet is not a direct result of neuropathic pain. Fractures from sudden loss of bone density are not caused by nerve damage. Infection spread through the bloodstream to the brain is not the safety risk linked to reduced temperature sensation.
Category: Types of Pain
Question 9
A patient whose leg was amputated last week reports cramping pain in the missing foot. What should the nurse do?
Accept the pain as real and assess it fully
✓
Remind the patient that the foot has been removed
Explain that the pain is imagined and will pass
Withhold assessment until a psychiatric consult
Correct Answer
Accept the pain as real and assess it fully
Phantom pain is a real neuropathic pain that the brain perceives as coming from the missing limb, so the nurse assesses and treats it like any other pain and rules out other causes such as infection at the stump. Reminding the patient that the foot has been removed dismisses a genuine symptom. Explaining that the pain is imagined is inaccurate and damages trust. Withholding assessment until a psychiatric consult delays care for a physical problem.
Category: Types of Pain
Question 10
A college athlete twisted an ankle during a game and arrives with fresh swelling. Which measure should the nurse apply first?
A heating pad set on low
A cold pack wrapped in a cloth
✓
Deep massage over the joint
A brisk walk to loosen the ankle
Correct Answer
A cold pack wrapped in a cloth
Right after an acute soft tissue injury, cold narrows blood vessels and numbs nerve endings, which limits swelling and pain; it is wrapped so it never touches the skin directly. A heating pad set on low widens blood vessels and can increase swelling in a fresh injury. Deep massage over the joint can worsen tissue damage in an acute sprain. A brisk walk to loosen the ankle puts weight on the injury when rest is needed.
Category: Nonpharmacologic Measures
Question 11
For which patient is heat therapy the better choice than cold therapy?
A patient who sprained a wrist moments ago
A patient with a fresh bruise on the thigh
A patient with long-standing low back stiffness
✓
A patient with a swollen knee from a fall today
Correct Answer
A patient with long-standing low back stiffness
Heat widens blood vessels and relaxes muscles, which eases the stiffness and aching of chronic problems such as long-standing back pain. A patient who sprained a wrist moments ago needs cold first to limit swelling. A patient with a fresh bruise on the thigh also benefits from cold, which reduces bleeding into the tissue. A patient with a swollen knee from a fall today has an acute injury, where heat could increase swelling.
Category: Nonpharmacologic Measures
Question 12
A patient asks about using a transcutaneous electrical nerve stimulation (TENS) unit for knee pain. Which finding in the history makes TENS inadvisable?
Osteoarthritis of the knee
Fibromyalgia
Diabetic nerve pain in the feet
An implanted cardiac pacemaker
✓
Correct Answer
An implanted cardiac pacemaker
TENS delivers electrical current through skin electrodes, and it is not recommended for a patient with an implanted electrical device such as a pacemaker. Osteoarthritis of the knee is a condition for which TENS has supporting evidence. Fibromyalgia is also among the conditions where TENS may help. Diabetic nerve pain in the feet is another condition for which TENS has been used with benefit.
Category: Nonpharmacologic Measures
Question 13
A massage therapist offers to treat a hospitalized patient's leg pain. Which condition makes massage of that leg unsafe?
A deep vein thrombosis in the calf
✓
Muscle tension after long bed rest
General anxiety about the hospital stay
Mild aching from sitting in one position
Correct Answer
A deep vein thrombosis in the calf
Massage over a known blood clot could dislodge it and send it to the lungs, so a deep vein thrombosis is a reason to avoid massaging that limb; massage also calls for caution with fractures, wounds, infection, weakened bones, and anticoagulant therapy. Muscle tension after long bed rest is a situation where massage can help. General anxiety about the hospital stay may also improve with massage. Mild aching from sitting in one position is a typical reason to offer massage.
Category: Nonpharmacologic Measures
Question 14
A patient's spouse presses the patient-controlled analgesia button while the patient is asleep "so the pain doesn't come back." Why does the nurse teach the spouse to stop?
The pump delivers a larger dose when anyone else presses it
A sleeping patient cannot press the button, which guards against oversedation
✓
Only the nurse is allowed to press the button at any time
Pressing the button while asleep disconnects the IV line
Correct Answer
A sleeping patient cannot press the button, which guards against oversedation
Patient-controlled analgesia is safe because a patient who becomes too drowsy stops pressing the button; when someone else presses it, that built-in check is lost and opioid-induced respiratory depression can follow. The pump does not deliver a larger dose when anyone else presses it; the danger is extra doses to a sedated patient. Saying only the nurse is allowed to press the button misstates the system, which is designed for the patient. Pressing the button while the patient is asleep does not disconnect the IV line.
Category: Barriers and Safety
Question 15
A hospitalized patient with a painful incision is woken repeatedly through the night for separate tasks. Which nursing action best supports this patient's rest and comfort?
Leave the overhead lights on for safety
Keep the door open to the busy hallway
Group care tasks into as few visits as possible
✓
Schedule each task at a separate time
Correct Answer
Group care tasks into as few visits as possible
Clustering care cuts down on interruptions so the patient can rest, which helps the patient cope with pain; dimming lights, lowering noise, and closing the door support the same goal. Leaving the overhead lights on for safety disrupts sleep. Keeping the door open to the busy hallway adds noise. Scheduling each task at a separate time increases the number of interruptions.
Category: Nonpharmacologic Measures
Question 16
A patient in recovery from opioid use disorder has severe pain after a hip fracture repair. Which approach reflects standard nursing care?
Avoid every analgesic so that relapse cannot occur
Give opioids without monitoring, since tolerance prevents side effects
Delay pain treatment until an addiction specialist sees the patient
Treat the pain fully, using nonopioid measures first and opioids with close monitoring if needed
✓
Correct Answer
Treat the pain fully, using nonopioid measures first and opioids with close monitoring if needed
Every patient has a right to adequate pain management; for a patient with opioid use disorder, nonpharmacologic and nonopioid measures are maximized first, and if opioids are needed they are not withheld; they are given with close monitoring and a shared plan, and any medication for opioid use disorder is continued. Avoiding every analgesic leaves severe pain untreated, which can itself raise relapse risk. Giving opioids without monitoring ignores the risk of oversedation. Delaying pain treatment until an addiction specialist sees the patient leaves the patient suffering when pain and the disorder can be managed together.
Category: Special Populations
Question 17
A patient asks for pain medication often and reports back pain that keeps coming back. During report, a nurse calls the patient "a pain seeker." What should the oncoming nurse do?
Perform a thorough pain assessment with follow-up questions
✓
Refuse further medication until the next shift
Document the patient as drug seeking
Offer a placebo to test the complaint
Correct Answer
Perform a thorough pain assessment with follow-up questions
Labeling a patient leads to dismissing real pain, so the nurse assesses the pain thoroughly and asks follow-up questions, which may reveal an untreated cause such as a kidney stone. Refusing further medication until the next shift acts on a label rather than an assessment. Documenting the patient as drug seeking spreads a stigmatizing judgment through the record. Offering a placebo to test the complaint is deceptive and does not reflect accepted pain care.
Category: Barriers and Safety
Question 18
A patient recovering from knee surgery has well-controlled pain at rest but severe pain during each physical therapy session. Which nursing action best addresses this pattern?
Cancel physical therapy until the pain fully resolves
Give the prescribed analgesic before the next therapy session
✓
Wait until the session ends and then assess the pain
Ask the therapist to skip the exercises that hurt
Correct Answer
Give the prescribed analgesic before the next therapy session
Pain that flares with activity can be anticipated, so giving the prescribed analgesic ahead of therapy lets it take effect before the session and helps the patient take part. Canceling physical therapy until the pain fully resolves delays recovery of function. Waiting until the session ends and then assessing the pain lets the flare happen. Asking the therapist to skip the exercises that hurt can leave the knee stiff and weak.
Category: Pain Assessment Skills
Question 19
A patient rates pain as mild on the numeric scale but is clenching the teeth, guarding the abdomen, and lying very still. What should the nurse do next?
Record the mild rating and take no other action
Disregard the rating and give the strongest analgesic
Explore the mismatch with further assessment
✓
Repeat the same numeric scale until the score rises
Correct Answer
Explore the mismatch with further assessment
When a patient's behavior does not match the score from a rating tool, the difference is a cue to assess further; the patient may be minimizing pain, may not understand the scale, or may have a new problem. Recording the mild rating and taking no other action ignores the physical cues. Disregarding the rating and giving the strongest analgesic skips assessment and risks harm. Repeating the same numeric scale until the score rises pressures the patient rather than clarifying the pain.
Category: Pain Assessment Skills
Question 20
After the nurse applies an elastic compression wrap to a patient's sprained wrist, which assessment is the priority?
The color of the bandage material
The patient's range of motion in the elbow
Skin condition on the opposite wrist
Circulation in the hand beyond the wrap
✓
Correct Answer
Circulation in the hand beyond the wrap
A compression wrap supports the injury, but if it is too tight it can cut off blood flow, so the nurse checks color, warmth, sensation, and capillary refill in the fingers beyond the wrap. The color of the bandage material has no clinical meaning. The patient's range of motion in the elbow is not affected by a wrist wrap. Skin condition on the opposite wrist does not show whether the wrapped hand is getting enough blood.
Category: Barriers and Safety