PAIN NCLEX QUESTIONS

Section 1

100

The nurse is preparing to discharge a client home with a prescription for ibuprofen. What should the nurse instruct as a common side effect of this medication? 1. Gastrointestinal (GI) bleeding 2. Shakiness 3. Tremors 4. Rash

Correct Answer: 1 Rationale 1: The most common side effect of NSAIDs, including ibuprofen, is gastrointestinal, such as heartburn or indigestion. Rationale 2: Shakiness is not a common side effect of NSAIDs. Rationale 3: Tremors are not a common side effect of NSAIDs. Rationale 4: A rash is not a common side effect of NSAIDs

200

Which of the following objective assessment data will the nurse obtain before administering a prescribed opioid medication to a client? 1. Pain level as stated by client 2. Any nausea the client may be feeling 3. Respiratory rate 4. Color of skin

Correct Answer: 3 Rationale 1: This is subjective data. Rationale 2: This is subjective data. Rationale 3: Opioids may depress the respiratory system, so the nurse should assess the respiratory rate before administering opioids. Rationale 4: This is not applicable to assess prior to administering an opioid medication to a client.

300

The client is taking meperidine (Demerol) and experiencing pruritus. Which of the following medications would the nurse expect the physician to order? 1. Naloxone hydrochloride (Narcan) 2. Acetaminophen (Tylenol) 3. Diphenhydramine hydrochloride (Benadryl) 4. Normal saline

Correct Answer: 3 Rationale 1: When clients experience pruritus, an antihistamine, such as Benadryl, is ordered. Rationale 2: When clients experience pruritus, an antihistamine, such as Benadryl, is ordered. Rationale 3: When clients experience pruritus, an antihistamine, such as Benadryl, is ordered. Rationale 4: When clients experience pruritus, an antihistamine, such as Benadryl, is ordered.

400

The nurse is providing discharge instructions to a client prescribed an opioid medication. What can the nurse suggest to decrease the risk of constipation with this medication? 1. Take an antihistamine three times per day. 2. Drink 6 to 8 glasses of water per day. 3. Assess respiratory rate before taking medication. 4. Assess heart rate before taking medication.

Correct Answer: 2 Rationale 1: Antihistamines do not prevent constipation. Rationale 2: Increasing fluid intake can help prevent constipation. Rationale 3: Assessing respiratory rate will not help prevent constipation. Rationale 4: Assessing heart rate will not impact the development of constipation.

500

A client is surprised to learn of the diagnosis of a heart attack when there was no chest pain experienced but only some left shoulder pain. What should the nurse explain to the client about the type of pain experienced? 1. Phantom pain 2. Referred pain 3. Visceral pain 4. Chronic pain

Correct Answer: 2 Rationale 1: Phantom pain is that which is experienced in a limb after an amputation. Rationale 2: Referred pain appears to arise in different areas of the body, as may occur with cardiac pain. Rationale 3: Visceral pain originates in an organ. Rationale 4: Chronic pain is that which is felt for months after the pain experience should have ended.

Section 2

100

The nurse is to administer acetaminophen (Tylenol) prn for a headache. The client has been vomiting all day. Which of the following routes should the nurse use to administer the medication? 1. Oral 2. Vaginal 3. Rectal 4. Intravenous

Correct Answer: 3 Rationale 1: The rectal route is often used if the client has nausea or vomiting. The nurse should administer an acetaminophen suppository to the client. Rationale 2: The rectal route is often used if the client has nausea or vomiting. The nurse should administer an acetaminophen suppository to the client. Rationale 3: The rectal route is often used if the client has nausea or vomiting. The nurse should administer an acetaminophen suppository to the client. Rationale 4: The rectal route is often used if the client has nausea or vomiting. The nurse should administer an acetaminophen suppository to the client.

200

A client rates pain as being 7 on a scale from 0 to 10. What will the nurse document as this client's pain intensity? 1. Mild pain 2. Moderate pain 3. Severe pain 4. Physiological pain

Correct Answer: 3 Rationale 1: Mild pain is rated as being from 1 to 3 on a 0 to 10 rating scale. Rationale 2: Moderate pain is rated as being from 4 to 6 on a 0 to 10 pain rating scale. Rationale 3: Severe pain is rated a 7-10 on a scale of 0 to 10. Rationale 4: Physiological pain does not describe the intensity of the client's pain.

300

A client is experiencing pain after spraining an ankle. The nurse realizes the type of pain the client is most likely experiencing would be: 1. Mild pain 2. Severe pain 3. Somatic pain 4. Visceral pain

Correct Answer: 3 Rationale 1: Mild is not a type of pain. Rationale 2: Severe is not a type of pain. Rationale 3: Somatic pain originates in the skin, muscles, bone, or connective tissue. The sharp sensation of a paper cut or aching of a sprained ankle are common examples of somatic pain. Rationale 4: Visceral pain is that which originates within an organ.

400

The nurse is performing discharge teaching for a client taking an NSAID. The client states he has heard taking an antacid with this medication will help decrease the incidence of upset stomach. The nurse's best response is: 1. "Antacids reduce the absorption and therefore the effectiveness of the NSAID." 2. "Antacids help to reduce the incidence of gastric bleeding that could occur with the use of NSAIDs." 3. "Antacids should never be taken with an NSAID." 4. "Antacids help to reduce the incidence of pain."

Correct Answer: 1 Rationale 1: It is documented that the use of antacids can reduce the risk of gastric distress, but can also reduce the absorption and the effectiveness of the medication. Rationale 2: Antacids can reduce the likelihood of gastric bleeding however will interfere with the absorption of the medication in the client. Rationale 3: This statement is not correct. Rationale 4: Antacids may reduce the pain associated with gastric distress however antacids are not a category of pain medication.

500

The client is admitted to the emergency department with complaints of abdominal pain. The client denies any nausea or vomiting. When asked, the client states the pain started 2 hours ago and describes the pain as "cramping." The client is most likely experiencing what type of pain? 1. Chronic pain 2. Phantom pain 3. Visceral pain 4. Acute pain

Correct Answer: 4 Rationale 1: Acute pain is pain that is directly related to tissue injury and resolves when tissue heals. Rationale 2: Acute pain is pain that is directly related to tissue injury and resolves when tissue heals. Rationale 3: Acute pain is pain that is directly related to tissue injury and resolves when tissue heals. Rationale 4: Acute pain is pain that is directly related to tissue injury and resolves when tissue heals.

Section 3

100

While conducting a pain assessment, the nurse knows to assess which of the following? (Select all that apply.) 1. Duration 2. Location 3. Intensity 4. Etiology 5. Neurology

Correct Answer: 1,2,3,4 Rationale 1: Pain may be described in terms of location, duration, intensity, and etiology. Rationale 2: Pain may be described in terms of location, duration, intensity, and etiology. Rationale 3: Pain may be described in terms of location, duration, intensity, and etiology. Rationale 4: Pain may be described in terms of location, duration, intensity, and etiology. Rationale 5: Pain may be described in terms of location, duration, intensity, and etiology.

200

The nurse is obtaining a comprehensive pain history on a client admitted with complaints of continuous low back pain. Which of the following should be included in the history? (Select all that apply.) 1. Pain location 2. Intensity 3. Quality 4. Alleviating factors 5. Past pain experiences 6. Effect on ADLs

Correct Answer: 1, 2, 3, 4, 5, 6 Rationale : All options should be obtained in the comprehensive pain history

300

A client experiencing pain has been prescribed aspirin. The nurse realizes that this medication will affect which pain process? 1. Transduction. 2. Transmission. 3. Perception. 4. Modulation.

Correct Answer: 1 Rationale 1: During the transduction phase, noxious stimuli trigger the release of biochemical mediators, such as prostaglandins, bradykinin, serotonin, histamine, and substance P, that sensitize nociceptors. Noxious or painful stimulation also causes movement of ions across cell membranes, which excites nociceptors. Pain medications such as ibuprofen or aspirin can work during this phase by blocking the production of prostaglandin or by decreasing the movement of ions across the cell membrane. Rationale 2: The transmission of pain includes three segments. During the first segment, the pain impulses travel from the peripheral nerve fibers to the spinal cord. The second segment is transmission from the spinal cord, and ascension, via spinothalamic tracts, to the brainstem and thalamus. The third segment involves transmission of signals between the thalamus to the somatic sensory cortex, where pain perception occurs. Pain control can take place during this second process of transmission. Opioids block the release of neurotransmitters, which stops the pain at the spinal level. Rationale 3: Perception is when the client becomes conscious of the pain. Pain perception is the sum of complex activities in the CNS that can shape the character and intensity of pain perceived and ascribes meaning to the pain. The psychosocial context of the situation and the meaning of the pain based on past experiences and future hopes and dreams help to shape the behavioral response that follows. Rationale 4: Modulation is often described as the “descending system,” and occurs when neurons in the thalamus and brainstem send signals back down to the dorsal horn of the spinal cord. These descending fibers release substances such as endogenous opioids, serotonin, and norepinephrine, which can inhibit the ascending painful impulses in the dorsal horn. In contrast, excitatory amino acids and the upregulation of excitatory glial cells can amplify these pain signals. The effects of excitatory amino acids and glial cells tend to persist, while the effects of the inhibitory neurotransmitters tend to be short-lived because they are reabsorbed into the nerves. Tricyclic antidepressants block the reuptake of norepinephrine and serotonin, and may be used to help diminish the pain signals.

400

A client is complaining of having the same type of pain that he experienced prior to being diagnosed with cancer. The nurse realizes that which process will influence this client’s perception of pain? 1. Transmission. 2. Modulation. 3. Perception. 4. Transduction.

Correct Answer: 3 Rationale 1: Transmission is a process by which the pain signals are transmitted to the brain. Rationale 2: Modulation is the process where signals are sent back down the spinal tracts in response to the pain. Rationale 3: Perception is when the client becomes conscious of the pain. Pain perception is the sum of complex activities in the CNS that can shape the character and intensity of pain perceived and ascribes meaning to the pain. The psychosocial context of the situation and the meaning of the pain based on past experiences and future hopes and dreams help to shape the behavioral response that follows. Rationale 4: Transduction is a process where chemicals are released in response to noxious stimuli.

500

A client tells the nurse that an ice pack works well to reduce the intensity of back pain. The nurse realizes that the client is implementing: 1. A placebo. 2. Distraction. 3. Guided imagery. 4. The gate control theory of pain.

Correct Answer: 4 Rationale 1: The application of ice is not a placebo. Rationale 2: The application of ice is not a distraction. Rationale 3: The application of ice not a use of guided imagery. Rationale 4: In the gate control theory, signals of noxious stimuli are carried to the dorsal horn, where they are modified according to the balance of the substantia gelatinosa. By using ice, the substantia gelatinosa is calmed, reducing the pain.

Section 4

100

A client recovering from hip surgery is reluctant to ambulate because of the amount of pain that occurred with walking prior to the surgery. What can the nurse do to help this client with pain control? 1. Provide pain medication before every ambulation session. 2. Address the client’s fear of pain with walking. 3. Tell the client that the pain is now gone. 4. Explain that the client is confusing postoperative pain with the pain before the surgery

Correct Answer: 2 Rationale 1: The client may not be prescribed pain medication before every ambulation session. Rationale 2: When using the gate control theory, nurses can use this model to stop nociceptor firing by applying topical therapies and addressing the client’s mood to reduce fear and anxiety. Rationale 3: The nurse needs to do more than tell the client that the pain is gone. Rationale 4: The client does not appear to be confused between the postoperative pain and the pain before the surgery.

200

The nurse is caring for an adolescent client who is experiencing postoperative pain. What interventions would be appropriate for the nurse identify to help this client? Standard Text: Select all that apply. 1. Talk with the client about pain. 2. Provide privacy. 3. Present choices for dealing with pain. 4. Encourage distraction with music or television. 5. Allay fears and anxiety.

Correct Answer: 1,2,3,4 Rationale 1: Nursing interventions to assist with pain management for an adolescent client include talking with the client about the pain. Rationale 2: Nursing interventions to assist with pain management for an adolescent client include providing privacy. Rationale 3: Nursing interventions to assist with pain management for an adolescent client include presenting choices for dealing with the pain. Rationale 4: Nursing interventions to assist with pain management for an adolescent client include encouraging distraction with music or television. Rationale 5: Allaying fears and anxiety would be a nursing intervention to assist with pain management for an adult.

300

The nurse is identifying diagnoses appropriate for a client experiencing pain. The client has had previous episodes of uncontrolled pain in the past, and is worried about the current pain pattern. Which diagnosis would be appropriate for the nurse to include for this client? 1. Anxiety. 2. Ineffective Coping. 3. Deficient Knowledge. 4. Hopelessness.

Correct Answer: 1 Rationale 1: The diagnosis of Anxiety would be appropriate for the client, since the client has past experiences of poor pain control and is anticipating pain. Rationale 2: The diagnosis of Ineffective Coping would be applicable if the client were experiencing prolonged pain because of ineffective pain management. Rationale 3: The diagnosis of Deficient Knowledge would be applicable if the client had a lack of exposure to information regarding pain management. Rationale 4: The diagnosis of Hopelessness would be appropriate if the client were experiencing continuous pain.

400

A client experiencing chronic pain is not getting relief with pain medication. What should the nurse do to help this client? 1. Ask the physician to change the prescribed pain medication. 2. Reassess the pain and consider another pain relief measure. 3. Limit interaction with the client. 4. Stop using alternative pain relief measures, if not effective.

Correct Answer: 2 Rationale 1: If a pain relief measure is ineffective, encourage the client to try it again before abandoning it. Medications might need repeated doses to saturate plasma proteins before sufficient “free drug” is available to work on the intended target. Rationale 2: Keep trying. Do not ignore a client because pain persists despite failed attempts to alleviate the discomfort. In these circumstances, reassess the pain and consider other relief measures. Rationale 3: The nurse should not ignore the client Rationale 4: Many nonpharmacologic measures require practice before they are effective.

500

An older client who refuses medication for pain is irritable and unable to sleep. What should the nurse explain to the client to encourage the use of pain medication? Standard Text: Select all that apply. 1. There are high-dose medications that will eradicate the pain. 2. The lack of pain control is causing the inability to sleep. 3. The lack of pain control is causing irritability. 4. The risks of taking pain medication are low in the older population. 5. The lack of pain control will affect mobility and activity tolerance.

Correct Answer: 2,3,5 Rationale 1: When planning pharmacologic intervention for an older client, the approach should be to start low and go slow because of the effects on renal and liver function. Rationale 2: If pain is not effectively controlled in the older client, the ability to sleep will be affected. Rationale 3: If pain is not effectively controlled in the older client, irritability can occur. Rationale 4: When planning pharmacologic intervention for an older client, the nurse must assess the client for potential risks because of changes in organ and system functioning. Rationale 5: If pain is not effectively controlled in the older client, mobility and activity tolerance will be affected.

Section 5

100

After receiving medication for mild pain, the client states that the pain is getting worse. What should the nurse plan to do for this client? 1. Administer another dose of a nonopioid medication. 2. Administer an opioid for severe pain. 3. Administer an opioid for moderate pain. 4. Administer two doses of an opioid for moderate pain.

Correct Answer: 3 Rationale 1: Since the client’s pain is persisting, the next step of the WHO ladder for pain control must be applied. Rationale 2: The next step of the WHO ladder for pain indicates that an opioid for moderate pain be provided, not an opioid for severe pain. Rationale 3: If the client has mild pain that persists or increases despite using full doses of step 1 medications, or if the pain is moderate, then a step 2 regimen is appropriate. At the second step, an opioid for moderate pain or a combination of opioid and nonopioid medicine is provided with or without coanalgesic medications. Rationale 4: The client should not receive two doses of an opioid for moderate pain at one time.

200

A client is diagnosed with chronic low back pain syndrome. The nurse realizes that the analgesic delivery route that might be beneficial for this client would be: 1. Topical. 2. Rectal. 3. Transmucosal. 4. Transdermal.

Correct Answer: 1 Rationale 1: Topical medications work directly at the point of application on the body. They are useful for painful procedures such as lumbar punctures or bone marrow biopsies, or for injections. These products can also offer effective pain relief for chronic pain syndromes such as low back pain. Rationale 2: The rectal route is useful for clients who have difficulty swallowing, or nausea and vomiting. Rationale 3: The transmucosal route is helpful for breakthrough pain because the oral mucosa is well vascularized, which facilitates rapid absorption. Rationale 4: The transdermal approach delivers a relatively stable plasma drug level, and is noninvasive. The medication, however, is systemic which might not be what is necessary for the client with chronic low back pain syndrome.

300

A client tells the nurse that at home, the dog helps distract the client from chronic hip pain. The nurse realizes that the client is utilizing which form of nonpharmacologic pain control? 1. Body. 2. Mind. 3. Social interactions. 4. Spirit.

Correct Answer: 3 Rationale 1: Interventions that target the body for pain control include massage, heat, and exercise. Rationale 2: Interventions that target the mind for pain control include relaxation and imagery. Rationale 3: Social interactions that are used as nonpharmacologic pain control methods include pet therapy. Rationale 4: Interventions that target the spirit for pain control include prayer, meditation, and energy work.

400

A client who is on postoperative day one from abdominal surgery is requesting a back rub. The nurse realizes this care should be provided by: 1. The registered nurse. 2. Unlicensed assistive personnel. 3. No one since, the client cannot assume the prone position. 4. The physician.

Correct Answer: 1 Rationale 1: Since the client is day one in recovery from abdominal surgery, the client’s condition might not be stable enough to have unlicensed assistive personnel perform the skill. Rationale 2: Although unlicensed assistive personnel might be able to perform the skill, the client’s condition might warrant that the nurse provide the back rub. Rationale 3: The client can assume a side-lying position for the back rub. Rationale 4: The nurse can provide the back rub. The physician does not need to be contacted to do this.

500

A client watching a comedy on television is laughing. When asked about the amount of pain on a scale from 0 to 10, the client reports a level that is 2 below the previous assessment. The nurse realizes the client’s pain was influenced by which type of distraction? 1. Visual. 2. Tactile. 3. Intellectual. 4. Behavioral.

Correct Answer: 1 Rationale 1: Visual distraction includes watching television. Rationale 2: Tactile distraction includes slow, rhythmic breathing or a massage. Rationale 3: Intellectual distraction includes crossword puzzles or engaging in hobby. Rationale 4: Behavioral is not a type of distraction.