NUR 170 COMPREHENSIVE EXAMINATION
Concepts of Medical-Surgical Nursing - Pain
Management
Galen College of Nursing (2026 Updated)
Question 1
A nurse is assessing a patient's pain. Which component is considered the BEST indicator of pain?
A. Vital sign changes
B. Patient's self-report
C. Facial expressions
D. Body positioning
Correct ANSWER: B
Rationale for Option A: Vital sign changes may indicate pain but are unreliable as the sole indicator
because the body adapts to chronic pain and vital signs often return to normal. Vital signs are subjective
and can be influenced by many other factors.
Rationale for Option B: Self-report is the gold standard and best indicator of pain because the patient is
the authority on their pain experience and the only one who can truly describe it. This is supported by
pain management guidelines and is especially important in nursing practice.
Rationale for Option C: Facial expressions can suggest pain but are not the best indicator as patients
may mask their expressions, have cultural differences in expressing pain, or be unable to show facial
changes due to various conditions.
Rationale for Option D: Body positioning may indicate discomfort but is not the most reliable indicator
as patients may guard or position themselves differently for various reasons unrelated to pain intensity.
Question 2
The nurse is conducting a comprehensive pain assessment. Which elements should be included? (Select
all that apply)
,A. Location of pain
B. Intensity of pain
C. Quality of pain
D. Patient's insurance information
E. Onset and duration
F. Aggravating and relieving factors
Correct ANSWER: A, B, C, E, F
Rationale for Option A: Location is essential to identify where the pain is occurring, whether it's
localized, radiating, or referred, which helps determine the underlying cause.
Rationale for Option B: Intensity measurement using a pain scale is crucial for establishing baseline,
monitoring effectiveness of interventions, and communicating pain levels among healthcare team
members.
Rationale for Option C: Quality (sharp, dull, aching, burning, etc.) helps differentiate types of pain
(nociceptive vs. neuropathic) and guides appropriate treatment selection.
Rationale for Option D: Insurance information is important for billing but is not part of the clinical pain
assessment and does not contribute to understanding or managing the patient's pain experience.
Rationale for Option E: Onset and duration help determine if pain is acute or chronic, identify patterns,
and assess whether the pain is related to specific events or conditions.
Rationale for Option F: Aggravating and relieving factors help identify triggers and effective
interventions, guiding the development of the pain management plan.
Question 3
A patient rates their pain as 8 on a 0-10 numeric rating scale. How should the nurse interpret this
finding?
A. Mild pain requiring non-pharmacological interventions only
B. Moderate pain requiring scheduled analgesics
C. Severe pain requiring immediate intervention
D. Acceptable pain level for post-operative patients
Correct ANSWER: C
Rationale for Option A: Mild pain is typically rated 1-3 on the numeric rating scale. A rating of 8 far
exceeds mild pain and requires more than non-pharmacological interventions alone.
Rationale for Option B: Moderate pain is typically rated 4-6 on the scale. A rating of 8 exceeds moderate
pain and indicates a more urgent need for intervention.
,Rationale for Option C: Severe pain is rated 7-10 on the numeric rating scale. A rating of 8 indicates
severe pain that requires immediate assessment and intervention to prevent complications and improve
patient outcomes.
Rationale for Option D: No pain level should be considered "acceptable" without evaluation. While some
post-operative pain is expected, a level of 8 indicates inadequate pain control requiring intervention.
Question 4
The nurse is caring for an elderly patient with dementia who cannot verbally communicate. Which pain
assessment tool would be MOST appropriate?
A. Numeric Rating Scale (0-10)
B. Wong-Baker FACES scale
C. Behavioral observation using body behaviors and physiological signs
D. Verbal Descriptor Scale
Correct ANSWER: C
Rationale for Option A: The Numeric Rating Scale requires the patient to understand numbers and
verbally report pain, which is not possible for patients with dementia who cannot communicate verbally.
Rationale for Option B: The Wong-Baker FACES scale requires cognitive ability to match facial
expressions to feelings, which may be impaired in patients with dementia.
Rationale for Option C: For cognitively impaired, critically ill, or non-communicative patients, nurses
must observe body behaviors (guarding, restlessness, facial expressions) and physiological signs (vital
sign changes, though these may be normal in chronic pain) to assess pain.
Rationale for Option D: The Verbal Descriptor Scale requires verbal communication and the ability to
choose descriptive words, which is not possible for patients who cannot communicate verbally.
Question 5
A patient with acute pain is experiencing fight or flight reactions. Which assessment findings would the
nurse expect? (Select all that apply)
A. Dilated pupils
B. Decreased blood pressure
C. Increased heart rate
D. Diaphoresis (sweating)
E. Decreased respiratory rate
F. Increased blood pressure
Correct ANSWER: A, C, D, F
, Rationale for Option A: Dilated pupils are a sympathetic nervous system response to acute pain as part
of the fight or flight reaction.
Rationale for Option B: Blood pressure typically increases, not decreases, during acute pain due to
sympathetic nervous system activation and release of stress hormones.
Rationale for Option C: Increased heart rate (tachycardia) is a common sympathetic response to acute
pain as the body prepares for fight or flight.
Rationale for Option D: Diaphoresis (sweating) is a common autonomic response to acute pain and the
stress response.
Rationale for Option E: Respiratory rate typically increases (tachypnea), not decreases, during acute pain
as part of the stress response.
Rationale for Option F: Increased blood pressure (hypertension) occurs during acute pain due to
sympathetic nervous system activation and vasoconstriction.
Question 6
The nurse is differentiating between acute and chronic pain. Which statement accurately describes
chronic pain?
A. Usually temporary with sudden onset
B. Easily localized to a specific area
C. Persists for 3 months or more
D. Vital signs are typically elevated
Correct ANSWER: C
Rationale for Option A: This describes acute pain, which is usually temporary with sudden onset. Chronic
pain is persistent and long-lasting.
Rationale for Option B: This describes acute pain, which is typically easily localized. Chronic pain is often
diffuse and harder to localize precisely.
Rationale for Option C: Chronic pain is defined as persistent pain that lasts or recurs for an indefinite
period, usually for 3 months or more, and may continue beyond the expected healing time.
Rationale for Option D: In chronic pain, the body adapts and vital signs are often normal or lower than
normal, unlike acute pain where vital signs are typically elevated.
Question 7
A patient has been experiencing pain for 4 months following a back injury. The pain is described as
constant and is affecting their ability to work. The patient reports feeling depressed and hopeless. What
type of pain is this patient experiencing?
A. Acute pain
Concepts of Medical-Surgical Nursing - Pain
Management
Galen College of Nursing (2026 Updated)
Question 1
A nurse is assessing a patient's pain. Which component is considered the BEST indicator of pain?
A. Vital sign changes
B. Patient's self-report
C. Facial expressions
D. Body positioning
Correct ANSWER: B
Rationale for Option A: Vital sign changes may indicate pain but are unreliable as the sole indicator
because the body adapts to chronic pain and vital signs often return to normal. Vital signs are subjective
and can be influenced by many other factors.
Rationale for Option B: Self-report is the gold standard and best indicator of pain because the patient is
the authority on their pain experience and the only one who can truly describe it. This is supported by
pain management guidelines and is especially important in nursing practice.
Rationale for Option C: Facial expressions can suggest pain but are not the best indicator as patients
may mask their expressions, have cultural differences in expressing pain, or be unable to show facial
changes due to various conditions.
Rationale for Option D: Body positioning may indicate discomfort but is not the most reliable indicator
as patients may guard or position themselves differently for various reasons unrelated to pain intensity.
Question 2
The nurse is conducting a comprehensive pain assessment. Which elements should be included? (Select
all that apply)
,A. Location of pain
B. Intensity of pain
C. Quality of pain
D. Patient's insurance information
E. Onset and duration
F. Aggravating and relieving factors
Correct ANSWER: A, B, C, E, F
Rationale for Option A: Location is essential to identify where the pain is occurring, whether it's
localized, radiating, or referred, which helps determine the underlying cause.
Rationale for Option B: Intensity measurement using a pain scale is crucial for establishing baseline,
monitoring effectiveness of interventions, and communicating pain levels among healthcare team
members.
Rationale for Option C: Quality (sharp, dull, aching, burning, etc.) helps differentiate types of pain
(nociceptive vs. neuropathic) and guides appropriate treatment selection.
Rationale for Option D: Insurance information is important for billing but is not part of the clinical pain
assessment and does not contribute to understanding or managing the patient's pain experience.
Rationale for Option E: Onset and duration help determine if pain is acute or chronic, identify patterns,
and assess whether the pain is related to specific events or conditions.
Rationale for Option F: Aggravating and relieving factors help identify triggers and effective
interventions, guiding the development of the pain management plan.
Question 3
A patient rates their pain as 8 on a 0-10 numeric rating scale. How should the nurse interpret this
finding?
A. Mild pain requiring non-pharmacological interventions only
B. Moderate pain requiring scheduled analgesics
C. Severe pain requiring immediate intervention
D. Acceptable pain level for post-operative patients
Correct ANSWER: C
Rationale for Option A: Mild pain is typically rated 1-3 on the numeric rating scale. A rating of 8 far
exceeds mild pain and requires more than non-pharmacological interventions alone.
Rationale for Option B: Moderate pain is typically rated 4-6 on the scale. A rating of 8 exceeds moderate
pain and indicates a more urgent need for intervention.
,Rationale for Option C: Severe pain is rated 7-10 on the numeric rating scale. A rating of 8 indicates
severe pain that requires immediate assessment and intervention to prevent complications and improve
patient outcomes.
Rationale for Option D: No pain level should be considered "acceptable" without evaluation. While some
post-operative pain is expected, a level of 8 indicates inadequate pain control requiring intervention.
Question 4
The nurse is caring for an elderly patient with dementia who cannot verbally communicate. Which pain
assessment tool would be MOST appropriate?
A. Numeric Rating Scale (0-10)
B. Wong-Baker FACES scale
C. Behavioral observation using body behaviors and physiological signs
D. Verbal Descriptor Scale
Correct ANSWER: C
Rationale for Option A: The Numeric Rating Scale requires the patient to understand numbers and
verbally report pain, which is not possible for patients with dementia who cannot communicate verbally.
Rationale for Option B: The Wong-Baker FACES scale requires cognitive ability to match facial
expressions to feelings, which may be impaired in patients with dementia.
Rationale for Option C: For cognitively impaired, critically ill, or non-communicative patients, nurses
must observe body behaviors (guarding, restlessness, facial expressions) and physiological signs (vital
sign changes, though these may be normal in chronic pain) to assess pain.
Rationale for Option D: The Verbal Descriptor Scale requires verbal communication and the ability to
choose descriptive words, which is not possible for patients who cannot communicate verbally.
Question 5
A patient with acute pain is experiencing fight or flight reactions. Which assessment findings would the
nurse expect? (Select all that apply)
A. Dilated pupils
B. Decreased blood pressure
C. Increased heart rate
D. Diaphoresis (sweating)
E. Decreased respiratory rate
F. Increased blood pressure
Correct ANSWER: A, C, D, F
, Rationale for Option A: Dilated pupils are a sympathetic nervous system response to acute pain as part
of the fight or flight reaction.
Rationale for Option B: Blood pressure typically increases, not decreases, during acute pain due to
sympathetic nervous system activation and release of stress hormones.
Rationale for Option C: Increased heart rate (tachycardia) is a common sympathetic response to acute
pain as the body prepares for fight or flight.
Rationale for Option D: Diaphoresis (sweating) is a common autonomic response to acute pain and the
stress response.
Rationale for Option E: Respiratory rate typically increases (tachypnea), not decreases, during acute pain
as part of the stress response.
Rationale for Option F: Increased blood pressure (hypertension) occurs during acute pain due to
sympathetic nervous system activation and vasoconstriction.
Question 6
The nurse is differentiating between acute and chronic pain. Which statement accurately describes
chronic pain?
A. Usually temporary with sudden onset
B. Easily localized to a specific area
C. Persists for 3 months or more
D. Vital signs are typically elevated
Correct ANSWER: C
Rationale for Option A: This describes acute pain, which is usually temporary with sudden onset. Chronic
pain is persistent and long-lasting.
Rationale for Option B: This describes acute pain, which is typically easily localized. Chronic pain is often
diffuse and harder to localize precisely.
Rationale for Option C: Chronic pain is defined as persistent pain that lasts or recurs for an indefinite
period, usually for 3 months or more, and may continue beyond the expected healing time.
Rationale for Option D: In chronic pain, the body adapts and vital signs are often normal or lower than
normal, unlike acute pain where vital signs are typically elevated.
Question 7
A patient has been experiencing pain for 4 months following a back injury. The pain is described as
constant and is affecting their ability to work. The patient reports feeling depressed and hopeless. What
type of pain is this patient experiencing?
A. Acute pain
