150 questions and correct answers for each of
the specified nursing topics (NURS 146–160).
The format is designed for study, review, and
test preparation.
NURS 146 – Pain Management
1. What is the "5th Vital Sign"?
Answer: Pain.
2. According to the World Health Organization (WHO) Analgesic Ladder, what is the first step for mild
pain?
Answer: Non-opioid analgesics (e.g., acetaminophen, NSAIDs) with or without adjuvants.
3. A patient rates their pain as an "8" but is smiling and watching TV. What is the most appropriate
nursing action?
Answer: Believe the patient’s self-report and administer prescribed analgesics.
4. What is neuropathic pain?
Answer: Pain caused by damage or dysfunction of the somatosensory nervous system (e.g., diabetic
neuropathy, post-herpetic neuralgia).
5. What is the mechanism of action of morphine?
Answer: Mu-opioid receptor agonist.
6. What is the antidote for opioid toxicity?
Answer: Naloxone (Narcan).
7. What non-pharmacological intervention is most effective for acute procedural pain in infants?
Answer: Sucrose (non-nutritive sucking).
8. Define breakthrough pain.
, Answer: A transient flare of pain that occurs despite stable, controlled baseline pain (often managed
with rapid-onset opioids).
9. What is the primary adverse effect of opioid analgesics that necessitates a bowel regimen?
Answer: Constipation.
10. Which adjuvant medication is commonly used for burning neuropathic pain?
Answer: Gabapentin or Pregabalin.
11. What is the FLACC scale used for?
Answer: Assessing pain in non-verbal patients or young children (Face, Legs, Activity, Cry,
Consolability).
12. A patient with liver disease should avoid which type of analgesic?
Answer: Acetaminophen (due to hepatotoxicity).
13. What is the difference between tolerance and physical dependence?
Answer: Tolerance is needing higher doses for the same effect; physical dependence is withdrawal
symptoms upon abrupt cessation. Neither equals addiction.
14. What is patient-controlled analgesia (PCA)?
Answer: A delivery system allowing the patient to self-administer preset doses of IV opioid,
maximizing autonomy and minimizing peaks/troughs.
15. What is the onset time for fentanyl transdermal patch?
Answer: 12–24 hours (delayed onset; requires rescue analgesia initially).
16. What is the gate control theory of pain?
Answer: Non-painful input (touch, massage) closes the "gates" to painful input in the spinal cord,
preventing pain signals from reaching the brain.
17. What is the maximum daily dose of acetaminophen for a healthy adult?
Answer: 3,000–4,000 mg (often reduced to 3,000 mg for chronic use).
18. What is the most common side effect of NSAIDs?
Answer: Gastrointestinal bleeding or irritation.
19. What is the term for pain that is perceived in a limb that has been amputated?
Answer: Phantom limb pain.
20. What is the PQRST mnemonic used for?
Answer: Pain assessment: Provocation/Palliation, Quality, Region/Radiation, Severity, Timing.
,21. What is the primary goal of palliative pain management?
Answer: Maximize comfort and quality of life, not necessarily prolong life.
22. What is the mechanism of action of Ketorolac (Toradol)?
Answer: NSAID; inhibits COX-1 and COX-2 to reduce prostaglandins.
23. What is the preferred route of opioid administration for severe acute pain in the hospital?
Answer: Intravenous (IV) for fastest titration.
24. What is the most serious respiratory risk associated with opioids?
Answer: Respiratory depression.
25. What is the role of a nerve block in pain management?
Answer: Interrupts nerve transmission to provide regional anesthesia/analgesia.
26. What is the difference between acute and chronic pain?
Answer: Acute pain lasts <3-6 months and has a protective function; chronic pain persists beyond
normal healing time.
27. What is the mechanism of action of acetaminophen?
Answer: Not fully understood; central COX inhibition and endocannabinoid system activation; minimal
peripheral anti-inflammatory effect.
28. What is the "equianalgesic" dose?
Answer: The dose of one opioid required to produce the same analgesic effect as another opioid.
29. What is the nursing priority when a patient on a PCA pump is lethargic and has a respiratory rate of
8?
Answer: Stop the PCA, stimulate the patient, and prepare naloxone.
30. What is the effect of alcohol on pain perception?
Answer: Can initially dull pain but increases inflammation and risk of liver damage when combined
with analgesics.
31. What type of pain is somatic pain?
Answer: Localized, sharp pain from skin, muscle, or bone (e.g., surgical incision).
32. What type of pain is visceral pain?
Answer: Diffuse, cramping, or squeezing pain from internal organs (e.g., pancreatitis).
33. What is a common adjuvant for bone pain?
Answer: Bisphosphonates (e.g., zoledronic acid) or NSAIDs.
, 34. What is the purpose of a "placebo" in pain management?
Answer: It is ethically unacceptable to use placebos to test for "real" pain; placebos are only used in
research with consent or when no standard treatment exists.
35. What is the most common barrier to effective pain management in the elderly?
Answer: Fear of addiction, under-reporting, and altered pharmacokinetics (polypharmacy).
36. What is the standard pain scale used for neonates?
Answer: NIPS (Neonatal Infant Pain Scale) or CRIES.
37. What is the primary reason to rotate opioids?
Answer: To manage tolerance or reduce side effects (e.g., opioid-induced hyperalgesia).
38. What is the role of corticosteroids in pain management?
Answer: Reduce inflammation and edema; used for spinal cord compression, bone pain, and
neuropathic pain.
39. What is the onset of action for IV morphine?
Answer: 1–5 minutes.
40. What is the effect of untreated pain on the cardiovascular system?
Answer: Increased heart rate, increased blood pressure, increased myocardial oxygen demand.
41. What is the role of the nurse in managing pain for a patient with substance use disorder?
Answer: Provide adequate pain relief without judgment; utilize multimodal analgesia and non-
pharmacological methods.
42. What is the mechanism of action of Ketamine in pain?
Answer: NMDA receptor antagonist; effective for neuropathic pain and reducing opioid tolerance.
43. What is the most common side effect of epidural opioids?
Answer: Pruritus (itching).
44. What is the definition of "allodynia"?
Answer: Pain due to a stimulus that does not normally provoke pain (e.g., light touch causing pain).
45. What is the definition of "hyperalgesia"?
Answer: Increased pain from a stimulus that normally provokes pain.
46. What is the nursing consideration for a patient receiving methadone for pain?
Answer: Risk for QT prolongation; monitor ECG.
47. What is the purpose of using a multimodal approach to pain?
the specified nursing topics (NURS 146–160).
The format is designed for study, review, and
test preparation.
NURS 146 – Pain Management
1. What is the "5th Vital Sign"?
Answer: Pain.
2. According to the World Health Organization (WHO) Analgesic Ladder, what is the first step for mild
pain?
Answer: Non-opioid analgesics (e.g., acetaminophen, NSAIDs) with or without adjuvants.
3. A patient rates their pain as an "8" but is smiling and watching TV. What is the most appropriate
nursing action?
Answer: Believe the patient’s self-report and administer prescribed analgesics.
4. What is neuropathic pain?
Answer: Pain caused by damage or dysfunction of the somatosensory nervous system (e.g., diabetic
neuropathy, post-herpetic neuralgia).
5. What is the mechanism of action of morphine?
Answer: Mu-opioid receptor agonist.
6. What is the antidote for opioid toxicity?
Answer: Naloxone (Narcan).
7. What non-pharmacological intervention is most effective for acute procedural pain in infants?
Answer: Sucrose (non-nutritive sucking).
8. Define breakthrough pain.
, Answer: A transient flare of pain that occurs despite stable, controlled baseline pain (often managed
with rapid-onset opioids).
9. What is the primary adverse effect of opioid analgesics that necessitates a bowel regimen?
Answer: Constipation.
10. Which adjuvant medication is commonly used for burning neuropathic pain?
Answer: Gabapentin or Pregabalin.
11. What is the FLACC scale used for?
Answer: Assessing pain in non-verbal patients or young children (Face, Legs, Activity, Cry,
Consolability).
12. A patient with liver disease should avoid which type of analgesic?
Answer: Acetaminophen (due to hepatotoxicity).
13. What is the difference between tolerance and physical dependence?
Answer: Tolerance is needing higher doses for the same effect; physical dependence is withdrawal
symptoms upon abrupt cessation. Neither equals addiction.
14. What is patient-controlled analgesia (PCA)?
Answer: A delivery system allowing the patient to self-administer preset doses of IV opioid,
maximizing autonomy and minimizing peaks/troughs.
15. What is the onset time for fentanyl transdermal patch?
Answer: 12–24 hours (delayed onset; requires rescue analgesia initially).
16. What is the gate control theory of pain?
Answer: Non-painful input (touch, massage) closes the "gates" to painful input in the spinal cord,
preventing pain signals from reaching the brain.
17. What is the maximum daily dose of acetaminophen for a healthy adult?
Answer: 3,000–4,000 mg (often reduced to 3,000 mg for chronic use).
18. What is the most common side effect of NSAIDs?
Answer: Gastrointestinal bleeding or irritation.
19. What is the term for pain that is perceived in a limb that has been amputated?
Answer: Phantom limb pain.
20. What is the PQRST mnemonic used for?
Answer: Pain assessment: Provocation/Palliation, Quality, Region/Radiation, Severity, Timing.
,21. What is the primary goal of palliative pain management?
Answer: Maximize comfort and quality of life, not necessarily prolong life.
22. What is the mechanism of action of Ketorolac (Toradol)?
Answer: NSAID; inhibits COX-1 and COX-2 to reduce prostaglandins.
23. What is the preferred route of opioid administration for severe acute pain in the hospital?
Answer: Intravenous (IV) for fastest titration.
24. What is the most serious respiratory risk associated with opioids?
Answer: Respiratory depression.
25. What is the role of a nerve block in pain management?
Answer: Interrupts nerve transmission to provide regional anesthesia/analgesia.
26. What is the difference between acute and chronic pain?
Answer: Acute pain lasts <3-6 months and has a protective function; chronic pain persists beyond
normal healing time.
27. What is the mechanism of action of acetaminophen?
Answer: Not fully understood; central COX inhibition and endocannabinoid system activation; minimal
peripheral anti-inflammatory effect.
28. What is the "equianalgesic" dose?
Answer: The dose of one opioid required to produce the same analgesic effect as another opioid.
29. What is the nursing priority when a patient on a PCA pump is lethargic and has a respiratory rate of
8?
Answer: Stop the PCA, stimulate the patient, and prepare naloxone.
30. What is the effect of alcohol on pain perception?
Answer: Can initially dull pain but increases inflammation and risk of liver damage when combined
with analgesics.
31. What type of pain is somatic pain?
Answer: Localized, sharp pain from skin, muscle, or bone (e.g., surgical incision).
32. What type of pain is visceral pain?
Answer: Diffuse, cramping, or squeezing pain from internal organs (e.g., pancreatitis).
33. What is a common adjuvant for bone pain?
Answer: Bisphosphonates (e.g., zoledronic acid) or NSAIDs.
, 34. What is the purpose of a "placebo" in pain management?
Answer: It is ethically unacceptable to use placebos to test for "real" pain; placebos are only used in
research with consent or when no standard treatment exists.
35. What is the most common barrier to effective pain management in the elderly?
Answer: Fear of addiction, under-reporting, and altered pharmacokinetics (polypharmacy).
36. What is the standard pain scale used for neonates?
Answer: NIPS (Neonatal Infant Pain Scale) or CRIES.
37. What is the primary reason to rotate opioids?
Answer: To manage tolerance or reduce side effects (e.g., opioid-induced hyperalgesia).
38. What is the role of corticosteroids in pain management?
Answer: Reduce inflammation and edema; used for spinal cord compression, bone pain, and
neuropathic pain.
39. What is the onset of action for IV morphine?
Answer: 1–5 minutes.
40. What is the effect of untreated pain on the cardiovascular system?
Answer: Increased heart rate, increased blood pressure, increased myocardial oxygen demand.
41. What is the role of the nurse in managing pain for a patient with substance use disorder?
Answer: Provide adequate pain relief without judgment; utilize multimodal analgesia and non-
pharmacological methods.
42. What is the mechanism of action of Ketamine in pain?
Answer: NMDA receptor antagonist; effective for neuropathic pain and reducing opioid tolerance.
43. What is the most common side effect of epidural opioids?
Answer: Pruritus (itching).
44. What is the definition of "allodynia"?
Answer: Pain due to a stimulus that does not normally provoke pain (e.g., light touch causing pain).
45. What is the definition of "hyperalgesia"?
Answer: Increased pain from a stimulus that normally provokes pain.
46. What is the nursing consideration for a patient receiving methadone for pain?
Answer: Risk for QT prolongation; monitor ECG.
47. What is the purpose of using a multimodal approach to pain?
