Sample NCLEX questions with rationale
PAIN
1. A chronic pain client reports to you, the charge nurse, that the nurse have not been responding
to requests for pain medication. What is your initial action?
a. Check the MARs and nurses’ notes for the past several days.
b. Ask the nurse educator to give an in-service about pain management.
c. Perform a complete pain assessment and history on the client.
d. Have a conference with the nurses responsible for the care of this client
2. Family members are encouraging your client to “tough it out” rather than run the risk of
becoming addicted to narcotics. The client is stoically abiding by the family’s wishes. Priority
nursing interventions for this client should target which dimension of pain?
a. Sensory
b. Affective
c. Sociocultural
d. Behavioral
e. Cognitive
3. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities
that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant
medication for this type of pain?
a. Amitriptyline (Elavil)
b. Corticosteroids
c. Methylphenidate (Ritalin)
d. Lorazepam (Ativan)
4. Which client is most likely to receive opioids for extended periods of time?
a. A client with fibrolyalgia
b. A client with phantom limb pain
c. A client with progressive pancreatic cancer
d. A client with trigeminal neuralgia
5. As the charge nurse, you are reviewing the charts of clients who were assigned to a newly
graduated RN. The RN has correctly charted dose and time of medication, but there is no
documentation regarding non-pharmaceutical measures. What action should you take first?
a. Make a note in the nurse’s file and continue to observe clinical performance
b. Refer the new nurse to the in-service education department.
c. Quiz the nurse about knowledge of pain management
d. Give praise for the correct dose and time and discuss the deficits in charting.
6. In caring for a young child with pain, which assessment tool is the most useful?
a. Simple description pain intensity scale
b. 0-10 numeric pain scale
c. Faces pain-rating scale
,d. McGill-Melzack pain questionnaire
7. In applying the principles of pain treatment, what is the first consideration?
a. Treatment is based on client goals.
b. A multidisciplinary approach is needed.
c. The client must be believed about perceptions of own pain.
d. Drug side effects must be prevented and managed.
8. Which route of administration is preferred if immediate analgesia and rapid titration are
necessary?
a. Intraspinal
b. Patient-controlled analgesia (PCA)
c. Intravenous (IV)
d. Sublingual
9. When titrating an analgesic to manage pain, what is the priority goal?
a. Administer smallest dose that provides relief with the fewest side effects.
b. Titrate upward until the client is pain free.
c. Titrate downwards to prevent toxicity.
d. Ensure that the drug is adequate to meet the client’s subjective needs.
10. In educating clients about non-pharmaceutical alternatives, which topic could you delegate to
an experienced LPN/LVN, who will function under your continued support and supervision?
a. Therapeutic touch
b. Use of heat and cold applications
c. Meditation
d. Transcutaneous electrical nerve stimulation (TENS)
11. Place the examples of drugs in the order of usage according to the World Health Organization
(WHO) analgesic ladder.
a. Morphine, hydromorphone, acetaminophen and lorazepam
b. NSAIDs and corticosteroids
c. Codeine, oxycodone and diphenhydramine
_____, _____, _____
12. Which client is at greater risk for respiratory depression while receiving opioids for
analgesia?
a. An elderly chronic pain client with a hip fracture
b. A client with a heroin addiction and back pain
c. A young female client with advanced multiple myeloma
d. A child with an arm fracture and cystic fibrosis
13. A client appears upset and tearful, but denies pain and refuses pain medication, because “my
sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
a. Encourage expression of fears on past experiences
b. Provide accurate information about use of pain medication
, c. Explain that addiction is unlikely among acute care clients.
d. Seek family assistance in resolving this problem.
14. A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What
is one of the first signs of withdrawal?
a. Fever
b. Nausea
c. Diaphoresis
d. Abdominal cramps
15. In caring for clients with pain and discomfort, which task is most appropriate to delegate to
the nursing assistant?
a. Assist the client with preparation of a sitz bath.
b. Monitor the client for signs of discomfort while ambulating
c. Coach the client to deep breathe during painful procedures
d. Evaluate relief after applying a cold application.
16. The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and
you feel very uncomfortable administering the medication. What is the first action that you
should take?
a. Prepare the medication and hand it to the physician
b. Check the hospital policy regarding use of the placebo.
c. Follow a personal code of ethics and refuse to give it.
d. Contact the charge nurse for advice.
17. For a cognitively impaired client who cannot accurately report pain, what is the first action
that you should take?
a. Closely assess for nonverbal signs such as grimacing or rocking.
b. Obtain baseline behavioral indicators from family members.
c. Look at the MAR and chart, to note the time of the last dose and response.
d. Give the maximum PRS dose within the minimum time frame for relief.
18. Which route of administration is preferable for administration of daily analgesics (if all body
systems are functional)?
a. IV
b. IM or subcutaneous
c. Oral
d. Transdermal
e. PCA
19. A first day post-operative client on a PCA pump reports that the pain control is inadequate.
What is the first action you should take?
a. Deliver the bolus dose per standing order.
b. Contact the physician to increase the dose.
c. Try non-pharmacological comfort measures.
d. Assess the pain for location, quality, and intensity.
PAIN
1. A chronic pain client reports to you, the charge nurse, that the nurse have not been responding
to requests for pain medication. What is your initial action?
a. Check the MARs and nurses’ notes for the past several days.
b. Ask the nurse educator to give an in-service about pain management.
c. Perform a complete pain assessment and history on the client.
d. Have a conference with the nurses responsible for the care of this client
2. Family members are encouraging your client to “tough it out” rather than run the risk of
becoming addicted to narcotics. The client is stoically abiding by the family’s wishes. Priority
nursing interventions for this client should target which dimension of pain?
a. Sensory
b. Affective
c. Sociocultural
d. Behavioral
e. Cognitive
3. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities
that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant
medication for this type of pain?
a. Amitriptyline (Elavil)
b. Corticosteroids
c. Methylphenidate (Ritalin)
d. Lorazepam (Ativan)
4. Which client is most likely to receive opioids for extended periods of time?
a. A client with fibrolyalgia
b. A client with phantom limb pain
c. A client with progressive pancreatic cancer
d. A client with trigeminal neuralgia
5. As the charge nurse, you are reviewing the charts of clients who were assigned to a newly
graduated RN. The RN has correctly charted dose and time of medication, but there is no
documentation regarding non-pharmaceutical measures. What action should you take first?
a. Make a note in the nurse’s file and continue to observe clinical performance
b. Refer the new nurse to the in-service education department.
c. Quiz the nurse about knowledge of pain management
d. Give praise for the correct dose and time and discuss the deficits in charting.
6. In caring for a young child with pain, which assessment tool is the most useful?
a. Simple description pain intensity scale
b. 0-10 numeric pain scale
c. Faces pain-rating scale
,d. McGill-Melzack pain questionnaire
7. In applying the principles of pain treatment, what is the first consideration?
a. Treatment is based on client goals.
b. A multidisciplinary approach is needed.
c. The client must be believed about perceptions of own pain.
d. Drug side effects must be prevented and managed.
8. Which route of administration is preferred if immediate analgesia and rapid titration are
necessary?
a. Intraspinal
b. Patient-controlled analgesia (PCA)
c. Intravenous (IV)
d. Sublingual
9. When titrating an analgesic to manage pain, what is the priority goal?
a. Administer smallest dose that provides relief with the fewest side effects.
b. Titrate upward until the client is pain free.
c. Titrate downwards to prevent toxicity.
d. Ensure that the drug is adequate to meet the client’s subjective needs.
10. In educating clients about non-pharmaceutical alternatives, which topic could you delegate to
an experienced LPN/LVN, who will function under your continued support and supervision?
a. Therapeutic touch
b. Use of heat and cold applications
c. Meditation
d. Transcutaneous electrical nerve stimulation (TENS)
11. Place the examples of drugs in the order of usage according to the World Health Organization
(WHO) analgesic ladder.
a. Morphine, hydromorphone, acetaminophen and lorazepam
b. NSAIDs and corticosteroids
c. Codeine, oxycodone and diphenhydramine
_____, _____, _____
12. Which client is at greater risk for respiratory depression while receiving opioids for
analgesia?
a. An elderly chronic pain client with a hip fracture
b. A client with a heroin addiction and back pain
c. A young female client with advanced multiple myeloma
d. A child with an arm fracture and cystic fibrosis
13. A client appears upset and tearful, but denies pain and refuses pain medication, because “my
sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
a. Encourage expression of fears on past experiences
b. Provide accurate information about use of pain medication
, c. Explain that addiction is unlikely among acute care clients.
d. Seek family assistance in resolving this problem.
14. A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What
is one of the first signs of withdrawal?
a. Fever
b. Nausea
c. Diaphoresis
d. Abdominal cramps
15. In caring for clients with pain and discomfort, which task is most appropriate to delegate to
the nursing assistant?
a. Assist the client with preparation of a sitz bath.
b. Monitor the client for signs of discomfort while ambulating
c. Coach the client to deep breathe during painful procedures
d. Evaluate relief after applying a cold application.
16. The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and
you feel very uncomfortable administering the medication. What is the first action that you
should take?
a. Prepare the medication and hand it to the physician
b. Check the hospital policy regarding use of the placebo.
c. Follow a personal code of ethics and refuse to give it.
d. Contact the charge nurse for advice.
17. For a cognitively impaired client who cannot accurately report pain, what is the first action
that you should take?
a. Closely assess for nonverbal signs such as grimacing or rocking.
b. Obtain baseline behavioral indicators from family members.
c. Look at the MAR and chart, to note the time of the last dose and response.
d. Give the maximum PRS dose within the minimum time frame for relief.
18. Which route of administration is preferable for administration of daily analgesics (if all body
systems are functional)?
a. IV
b. IM or subcutaneous
c. Oral
d. Transdermal
e. PCA
19. A first day post-operative client on a PCA pump reports that the pain control is inadequate.
What is the first action you should take?
a. Deliver the bolus dose per standing order.
b. Contact the physician to increase the dose.
c. Try non-pharmacological comfort measures.
d. Assess the pain for location, quality, and intensity.
