1
NCLEX RN Exam Bank: Opioid Safety, Pain
Scales, Titration & Addiction Risks
Table of Contents
Subtopic 1: Pain Assessment and Pain Scale Interpretation ............................................. 2
Subtopic 2: Opioid Titration and Individualized Dosing (Q21–Q40) .................................. 11
Subtopic 3: Opioid Adverse Effects, Overdose Monitoring & Naloxone Use (Q41–Q60) ..... 20
Subtopic 4: Opioid Use in Special Populations (Pediatrics, Elderly, Pregnancy) (Q61–Q80)29
Subtopic 5: Monitoring for Side Effects and Managing Opioid-Induced Complications (Q81–
Q100) ......................................................................................................................... 38
Subtopic 6: Geriatric Considerations and Opioid Use in Older Adults (Q101–Q120) ......... 46
Subtopic 7: Opioid Use in End-of-Life and Palliative Care Settings (Q121–Q140) .............. 53
Subtopic 8: Opioid Use in the Elderly and Cognitively Impaired Patients (Q141–Q160) ..... 62
Subtopic 9: Opioids in Special Populations—Pediatrics, Geriatrics, and Pregnancy (Q161–
180) ........................................................................................................................... 71
Subtopic 10: Legal, Ethical, and Documentation Standards in Opioid Administration (Q181–
Q200) ......................................................................................................................... 80
, 2
Subtopic 1: Pain Assessment and Pain Scale
Interpretation
Question 1:
A nurse is assessing a non-verbal post-operative patient for pain. Which of the following
tools is most appropriate for this assessment?
A. Numeric Rating Scale (0–10)
B. Wong-Baker FACES Scale
C. Behavioral Pain Scale (BPS)
D. Verbal Descriptor Scale
Correct answer: C. Behavioral Pain Scale (BPS)
Rationale: The BPS is appropriate for non-verbal or intubated patients as it assesses facial
expression, limb movement, and ventilator compliance instead of self-report.
Question 2:
A patient rates their pain as 8/10 using a Numeric Rating Scale. Which nursing action is
most appropriate?
A. Document the pain and continue monitoring
B. Administer the prescribed opioid analgesic
C. Offer a back massage and re-evaluate in an hour
D. Notify the physician of non-compliance
Correct answer: B. Administer the prescribed opioid analgesic
Rationale: A pain score of 8/10 indicates severe pain requiring immediate pharmacologic
intervention if opioids are ordered.
, 3
Question 3:
Which pain assessment tool is best suited for use in a 4-year-old child?
A. Numeric Pain Scale
B. Wong-Baker FACES Scale
C. Verbal Descriptor Scale
D. McGill Pain Questionnaire
Correct answer: B. Wong-Baker FACES Scale
Rationale: This tool uses facial expressions that children can relate to and is validated for
ages 3 and older.
Question 4:
A nurse observes a dementia patient moaning and guarding their abdomen. What should
the nurse do first?
A. Use a pain scale appropriate for cognitive impairment
B. Administer a placebo
C. Wait for the patient to verbalize pain
D. Chart “unable to assess pain”
Correct answer: A. Use a pain scale appropriate for cognitive impairment
Rationale: Tools like PAINAD are designed to assess pain in patients with cognitive
impairment using behavioral cues.
Question 5:
, 4
Which statement by a patient best supports a nurse’s assessment that the patient is
experiencing neuropathic pain?
A. “It feels like a dull ache in my back.”
B. “It feels like pins and needles in my feet.”
C. “It hurts more when I move.”
D. “It comes and goes with stress.”
Correct answer: B. “It feels like pins and needles in my feet.”
Rationale: Neuropathic pain often manifests as burning, tingling, or electric-like
sensations.
Question 6:
A post-op patient refuses to report pain but is restless and grimacing. What is the nurse’s
priority action?
A. Respect the patient’s silence
B. Reassess in 30 minutes
C. Use a behavioral scale to assess pain
D. Discontinue opioid medications
Correct answer: C. Use a behavioral scale to assess pain
Rationale: Objective tools like the Behavioral Pain Scale help assess patients who are non-
verbal or refuse to self-report.
Question 7:
A nurse is caring for a non-verbal child in pain. Which tool is most appropriate?
NCLEX RN Exam Bank: Opioid Safety, Pain
Scales, Titration & Addiction Risks
Table of Contents
Subtopic 1: Pain Assessment and Pain Scale Interpretation ............................................. 2
Subtopic 2: Opioid Titration and Individualized Dosing (Q21–Q40) .................................. 11
Subtopic 3: Opioid Adverse Effects, Overdose Monitoring & Naloxone Use (Q41–Q60) ..... 20
Subtopic 4: Opioid Use in Special Populations (Pediatrics, Elderly, Pregnancy) (Q61–Q80)29
Subtopic 5: Monitoring for Side Effects and Managing Opioid-Induced Complications (Q81–
Q100) ......................................................................................................................... 38
Subtopic 6: Geriatric Considerations and Opioid Use in Older Adults (Q101–Q120) ......... 46
Subtopic 7: Opioid Use in End-of-Life and Palliative Care Settings (Q121–Q140) .............. 53
Subtopic 8: Opioid Use in the Elderly and Cognitively Impaired Patients (Q141–Q160) ..... 62
Subtopic 9: Opioids in Special Populations—Pediatrics, Geriatrics, and Pregnancy (Q161–
180) ........................................................................................................................... 71
Subtopic 10: Legal, Ethical, and Documentation Standards in Opioid Administration (Q181–
Q200) ......................................................................................................................... 80
, 2
Subtopic 1: Pain Assessment and Pain Scale
Interpretation
Question 1:
A nurse is assessing a non-verbal post-operative patient for pain. Which of the following
tools is most appropriate for this assessment?
A. Numeric Rating Scale (0–10)
B. Wong-Baker FACES Scale
C. Behavioral Pain Scale (BPS)
D. Verbal Descriptor Scale
Correct answer: C. Behavioral Pain Scale (BPS)
Rationale: The BPS is appropriate for non-verbal or intubated patients as it assesses facial
expression, limb movement, and ventilator compliance instead of self-report.
Question 2:
A patient rates their pain as 8/10 using a Numeric Rating Scale. Which nursing action is
most appropriate?
A. Document the pain and continue monitoring
B. Administer the prescribed opioid analgesic
C. Offer a back massage and re-evaluate in an hour
D. Notify the physician of non-compliance
Correct answer: B. Administer the prescribed opioid analgesic
Rationale: A pain score of 8/10 indicates severe pain requiring immediate pharmacologic
intervention if opioids are ordered.
, 3
Question 3:
Which pain assessment tool is best suited for use in a 4-year-old child?
A. Numeric Pain Scale
B. Wong-Baker FACES Scale
C. Verbal Descriptor Scale
D. McGill Pain Questionnaire
Correct answer: B. Wong-Baker FACES Scale
Rationale: This tool uses facial expressions that children can relate to and is validated for
ages 3 and older.
Question 4:
A nurse observes a dementia patient moaning and guarding their abdomen. What should
the nurse do first?
A. Use a pain scale appropriate for cognitive impairment
B. Administer a placebo
C. Wait for the patient to verbalize pain
D. Chart “unable to assess pain”
Correct answer: A. Use a pain scale appropriate for cognitive impairment
Rationale: Tools like PAINAD are designed to assess pain in patients with cognitive
impairment using behavioral cues.
Question 5:
, 4
Which statement by a patient best supports a nurse’s assessment that the patient is
experiencing neuropathic pain?
A. “It feels like a dull ache in my back.”
B. “It feels like pins and needles in my feet.”
C. “It hurts more when I move.”
D. “It comes and goes with stress.”
Correct answer: B. “It feels like pins and needles in my feet.”
Rationale: Neuropathic pain often manifests as burning, tingling, or electric-like
sensations.
Question 6:
A post-op patient refuses to report pain but is restless and grimacing. What is the nurse’s
priority action?
A. Respect the patient’s silence
B. Reassess in 30 minutes
C. Use a behavioral scale to assess pain
D. Discontinue opioid medications
Correct answer: C. Use a behavioral scale to assess pain
Rationale: Objective tools like the Behavioral Pain Scale help assess patients who are non-
verbal or refuse to self-report.
Question 7:
A nurse is caring for a non-verbal child in pain. Which tool is most appropriate?
