Question 1

What is Diclofenac used for?

Accepted Answer

Answer reason: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve mild to moderate pain, inflammation, and swelling. It works by inhibiting prostaglandin synthesis, which reduces pain perception and inflammatory response.

Question 2

The nurse is planning care for a client during the acute phase of a sickle cell vaso-occlusive crisis. Which of the following actions would be most appropriate?

Accepted Answer

Answer reason: An acute vaso-occlusive crisis causes severe ischemic pain. The priority in management is aggressive pain control with analgesics, along with hydration and rest. Fluid restriction is contraindicated; ambulation increases oxygen demand and pain; increased calories are not the immediate priority.

Question 3

A client admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates an understanding of phantom limb pain?

Accepted Answer

Answer reason: Phantom limb pain is real pain resulting from neural pathway changes after amputation; it should be acknowledged and treated with analgesics. It is not purely psychological, not necessarily transient, and not explained by a prior infection.

Question 4

A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client's temperature is 100.8°F. The PRIORITY nursing goal for this client is?

Accepted Answer

Answer reason: Renal colic causes severe, acute pain; the immediate priority is to relieve pain. The patient is otherwise stable, so pain management takes precedence over nausea control or infection prevention.

Question 5

The doctor has ordered a patient-controlled analgesia (PCA) pump for the client with chronic pain. The client asks the nurse if he can become overdosed on pain medication using this machine. The nurse demonstrates understanding of the PCA if she states?

Accepted Answer

Answer reason: PCA pumps include a lockout interval that limits how often a dose may be delivered, reducing the risk of overdose. Options A and C misstate how PCA works, and D is vague and does not address the overdose concern.

Question 6

Which of the following can be used to determine if a prescribed pain management therapy is effective for a nonverbal patient?

Accepted Answer

Answer reason: Pain in nonverbal patients can be assessed using behavioral scales such as the Faces Rating Scale, allowing evaluation of analgesic effectiveness. The Pap test screens for cervical cancer, the Braden Scale assesses pressure ulcer risk, and the Apgar evaluates newborn status.

Question 7

The nurse is caring for an 81-year-old client with colorectal cancer. The client's pain has been managed until now with acetaminophen with codeine. Because of increased pain, the order is changed to morphine. The nurse recognizes that this order is?

Accepted Answer

Answer reason: Opioids like morphine are appropriate for severe, persistent cancer pain, even in elderly clients, with careful monitoring for side effects.

Question 8

When managing pain caused by joint or muscle bleeding in patients with hemophilia A, the first strategy that should be used is?

Accepted Answer

Answer reason: NSAIDs (e.g., nimesulide, celecoxib) can increase bleeding risk in hemophilia. First-line analgesic is acetaminophen; opioids are reserved for more severe pain.

Question 9

The nurse is performing an assessment of an elderly client who has had a total hip repair. Based on this assessment, the nurse decides to medicate the client with an analgesic. Which finding most likely prompted the nurse to administer the analgesic?

Accepted Answer

Answer reason: Facial grimacing during care is a direct, observable indicator of pain and best justifies administering an analgesic. The other findings are nonspecific; BP 130/86 is within normal limits.

Question 10

As part of chemotherapy education, the nurse teaches a female client about the risk of bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement?

Accepted Answer

Answer reason: Aspirin impairs platelet aggregation, increasing bleeding risk during thrombocytopenia caused by chemotherapy. The client’s plan to take aspirin shows a lack of understanding of safety precautions during the nadir period.

Question 11

Drugs of choice to control pain in acute pancreatitis?

Accepted Answer

Answer reason: Meperidine has been traditionally preferred for acute pancreatitis pain because it is less likely than morphine to cause sphincter of Oddi spasm; NSAIDs or codeine are inadequate for severe pain.

Question 12

A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?

Accepted Answer

Answer reason: Phantom limb pain is real neuropathic pain from nerve pathway disruption and should be treated; it is not purely psychological, not due to infection, and may persist beyond a few days.

Question 13

During the early postoperative period, a client who has undergone a cataract extraction complains of nausea and severe eye pain over the operative site. What should be the initial nursing action?

Accepted Answer

Answer reason: Severe eye pain and nausea after cataract surgery can indicate increased intraocular pressure and risk of hemorrhage. The priority initial action is to relieve pain and stop nausea/vomiting by administering the prescribed analgesic and antiemetic; notify the HCP if not relieved. Reassurance or turning to the operative side is inappropriate.

Question 14

A client with chronic pain is being treated with opioid administration via epidural route. Which medication would it be most important to have available due to a possible complication of this pain relief procedure?

Accepted Answer

Answer reason: Epidural opioids can cause life-threatening respiratory depression; naloxone is the opioid antagonist needed for rapid reversal. The other options treat pain, allergy, or nausea but do not reverse opioid toxicity.

Question 15

Which medication should the nurse administer prior to a dressing change for a client with a 27% total body surface area burn consisting of second- and third-degree burns?

Accepted Answer

Answer reason: Burn dressing changes cause severe procedural pain; the most appropriate option is a rapid-onset, short-acting IV opioid. Hydromorphone IV push provides fast, potent analgesia.

Question 16

What action should the nurse take to ensure a client scheduled for hydrotherapy for a burn dressing change is comfortable during the procedure?

Accepted Answer

Answer reason: Hydrotherapy and burn dressing changes are very painful; the nurse should premedicate with an opioid 30–60 minutes prior so analgesia peaks during the procedure. Other options do not address pain control

Question 17

A client with chronic pain reports inadequate relief despite receiving prescribed analgesics; which intervention should the nurse prioritize?

Accepted Answer

Answer reason: Assessment comes first. A thorough pain assessment is needed to determine characteristics, causes, and effectiveness of current therapy before changing dosages, adding sedatives, or suggesting alternatives.

Question 18

What is the priority nursing goal for a client admitted with renal calculi who is experiencing moderate to severe flank pain and nausea with a temperature of 100.8°F?

Accepted Answer

Answer reason: Renal calculi typically cause acute, severe colicky flank pain. The immediate nursing priority is to relieve pain; nausea control, hydration, and infection prevention are important but secondary. A low-grade fever does not supersede the urgent need for analgesia.

Question 19

A client is receiving chemotherapy and reports mouth sores. What nursing intervention is appropriate for managing chemotherapy-induced stomatitis?

Accepted Answer

Answer reason: Topical anesthetics (e.g., viscous lidocaine) relieve oral pain from chemotherapy-induced stomatitis. Hot/spicy foods and vigorous brushing irritate mucosa, and aspirin increases bleeding risk in myelosuppressed clients.

Question 20

A postoperative client is experiencing severe pain. What is the most appropriate action for the nurse?

Accepted Answer

Answer reason: For severe postoperative pain, the priority is to promptly administer prescribed analgesics. Distraction and documentation are adjuncts but should not delay pharmacologic relief, and waiting for the client to request pain relief is inappropriate.

Question 21

A client is admitted with acute pancreatitis. What is the priority nursing intervention?

Accepted Answer

Answer reason: Acute pancreatitis causes severe abdominal pain; the immediate priority is analgesia. Vital signs q4h is routine, high-fiber diet is inappropriate (patient is typically NPO), and PPIs may be ordered but are not the priority nursing intervention.

Question 22

Combination products containing opioids and non-opioids are commonly used for the management of moderate to severe what type of pain?

Accepted Answer

Answer reason: Opioid–nonopioid combination analgesics (e.g., hydrocodone/acetaminophen) are standard for moderate to severe acute pain such as postoperative or injury pain. Neuropathic pain responds better to anticonvulsants/antidepressants, and migraines require migraine-specific therapy.

Question 23

A client is admitted with a diagnosis of renal calculi. The nurse should give priority to?

Accepted Answer

Answer reason: Renal colic causes severe acute pain; the immediate priority is analgesia. Hydration and urine straining are important but follow after pain control.

Question 24

A client complains of sharp, stabbing pain in the right lower quadrant that is graded as level 8 on a scale of 10. The nurse knows that pain of this severity can best be managed using?

Accepted Answer

Answer reason: An 8/10 pain score indicates severe pain; first-line management is a strong opioid. Morphine provides superior analgesia for severe acute pain compared with NSAIDs or acetaminophen with codeine.

Question 25

The physician has ordered an injection of morphine for a client with post-operative pain. Before administering the medication, it is essential that the nurse assess the client's?

Accepted Answer

Answer reason: Opioid analgesics like morphine can cause respiratory depression. Assess respiratory rate and depth before administration and hold if inadequate.

Question 26

The doctor has ordered Percocet (oxycodone) for a client following abdominal surgery. The primary objective of nursing care for the client receiving an opiate analgesic is?

Accepted Answer

Answer reason: The primary goal of opioid analgesic therapy after surgery is effective pain relief; preventing side effects or addiction is secondary.

Question 27

Which tablet is used for pain?

Accepted Answer

Answer reason: Naproxen is an NSAID analgesic used to relieve pain. Loperamide is an antidiarrheal, ciprofloxacin is an antibiotic, and cetirizine is an antihistamine.

Question 28

Prolonged use of opioid analgesics may lead to the development of which condition?

Accepted Answer

Answer reason: Chronic opioid use leads to pharmacologic tolerance, requiring higher doses for the same effect. Allergy is not dose-duration dependent, nausea is an acute side effect, and anemia is unrelated.

Question 29

You are teaching a client about the client Controlled Analgesia (PCA) planned for post-operative care. Which indicates FURTHER teaching may be needed by the client?

Accepted Answer

Answer reason: With PCA, the client self-administers demand doses within programmed limits and does not need to call the nurse before pressing the button. They should notify the nurse if pain is uncontrolled; lockout features help prevent overdose.

Question 30

A post-operative client has a prescription for acetaminophen with codeine. The nurse recognizes that a primary effect of this combination is to?

Accepted Answer

Answer reason: Combining a non-opioid (acetaminophen) with an opioid (codeine) provides additive/synergistic analgesia, resulting in greater pain relief than either alone. It does not primarily minimize side effects, prevent tolerance, or speed onset.

Question 31

Which of the following statements is both a correctly stated nursing diagnosis and a high priority for a 65-year-old client immediately following a modified radical mastectomy and axillary dissection?

Accepted Answer

Answer reason: Acute postoperative pain is the highest physiological priority because uncontrolled pain can impair ventilation, mobility, and wound healing. Immediate pharmacologic pain management is required after major surgery.

Question 32

The nurse is caring for a client with renal calculi. Which physician order would be a PRIORITY?

Accepted Answer

Answer reason: Renal calculi cause severe renal colic; the immediate priority is rapid pain relief. PCA morphine provides prompt analgesia. Fluids and warm compresses are supportive but not first priority, and antibiotics are only indicated if infection is present.

Question 33

A nurse admits a client transferred from the emergency room. The client, diagnosed with a myocardial infarction, is complaining of substernal chest pain, diaphoresis and nausea. The FIRST action by the nurse should be?

Accepted Answer

Answer reason: In acute MI, unrelieved pain increases sympathetic tone and myocardial oxygen demand, risking extension of infarction. Priority is to relieve pain promptly (e.g., morphine/nitro) per order. A nurse does not "order" an EKG; starting an IV and taking vitals are important but not the first priority over pain control.

Question 34

In order to enhance a client's response to medication for chest pain from acute angina, the nurse should emphasize?

Accepted Answer

Answer reason: Reducing anxiety through relaxation decreases sympathetic stimulation and can improve the effectiveness of angina pain medications such as nitroglycerin.

Question 35

A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse enters the room to request something for pain. The nurse should?

Accepted Answer

Answer reason: Sickle cell crisis causes severe pain that should be treated promptly with prescribed analgesics. Placebos are unethical; hydration and relaxation are adjuncts but not the priority when the client requests pain relief.

Question 36

The nurse planning care for a 12 year-old child with sickle cell disease in a vaso-occlusive crisis of the elbow should include which one of the following as a PRIORITY?

Accepted Answer

Answer reason: Vaso-occlusive crisis causes severe ischemic pain; priority is pain relief. A 12-year-old can safely use PCA. Fluids should be encouraged, cold causes vasoconstriction, and ROM is avoided during acute pain.

Question 37

Pethidine injection is used for?

Accepted Answer

Answer reason: Pethidine (meperidine) is an opioid agonist used for the relief of moderate to severe acute pain, including postoperative and obstetric pain. It acts primarily at mu-opioid receptors to produce analgesia. It has no antimicrobial activity, so it does not treat infections such as gonorrhea, cystitis, or tuberculosis, which require specific antimicrobial therapy.

Question 38

Which client is most likely to receive opioids for extended periods of time?

Accepted Answer

Answer reason: Cancer-related pain, particularly from progressive pancreatic cancer, often requires long-term opioid therapy due to ongoing tissue invasion and high nociceptive burden; this aligns with the WHO analgesic ladder for cancer pain. Fibromyalgia is better managed with non-opioid agents such as SNRIs or pregabalin and nonpharmacologic modalities. Phantom limb pain and trigeminal neuralgia typically respond to adjuvants like anticonvulsants or TCAs rather than chronic opioids. Therefore, the client with progressive cancer is the most likely to need extended opioid treatment.

Question 39

A nurse is caring for a patient who is recovering from surgery and is in pain at the incision site. The nurse has administered some medications to help control the patient's pain, but she holds off from administering more because she does not want the patient's respiratory rate to drop. Which is another example of a reason why some nurses fail to utilize appropriate pain management techniques when caring for a patient in pain?

Accepted Answer

Answer reason: Undertreatment of pain commonly stems from misconceptions such as fear of patient addiction to analgesics, especially opioids. Evidence shows the risk of addiction in appropriately treated acute pain is low, and careful monitoring can mitigate adverse effects. Such fears can lead to withholding indicated analgesia and inadequate pain control.

Question 40

A postoperative client receiving IV morphine reports increasing drowsiness and needs frequent reminders to stay awake. Respiratory rate is 10/min. What is the nurse’s best first action?

Accepted Answer

Answer reason: Early opioid-induced sedation + RR decrease (10/min) requires **withholding the opioid** and contacting the provider. Naloxone is reserved for more severe respiratory depression or unresponsiveness.

Question 41

A client with chronic osteoarthritis takes ibuprofen daily for pain. Which finding requires the nurse to intervene?

Accepted Answer

Answer reason: NSAIDs increase gastric irritation and bleeding risk. A **history of peptic ulcer disease** is a major red flag requiring alternative pain therapy.

Question 42

A client with diabetic neuropathy reports burning, shooting leg pain that is not relieved by acetaminophen. Which medication class is most appropriate to discuss with the provider?

Accepted Answer

Answer reason: Neuropathic pain responds best to **adjuvant agents** such as gabapentin or pregabalin. Acetaminophen, NSAIDs, and opioids have limited effectiveness for nerve pain.

Question 43

A postoperative client using a PCA pump reports good pain relief but feels very sleepy. The family asks if they can press the PCA button for the client while the client rests. What is the nurse’s best response?

Accepted Answer

Answer reason: Only the client may activate PCA dosing. Family-activated dosing increases overdose and respiratory depression risk because it bypasses the client’s natural sedation limit.

Question 44

A client with cancer taking long-acting morphine reports new severe pain rated 9/10. The nurse reviews the orders and finds a short-acting opioid available. What is the appropriate action?

Accepted Answer

Answer reason: Clients on long-acting opioids often require **short-acting agents** for sudden flares of severe pain. Withholding rescue doses results in inadequate pain control.

Question 45

A client receiving opioids for postoperative pain reports nausea and itching but states the pain relief is effective. What is the nurse’s best action?

Accepted Answer

Answer reason: Opioid side effects such as nausea or itching are common and often manageable with adjunct medications. Stopping or altering the opioid without provider direction may compromise pain control.

Question 46

A client receiving IV hydromorphone reports persistent pain rated 8/10 despite scheduled dosing. The nurse notes the client is alert with stable vital signs. What is the nurse’s best action?

Accepted Answer

Answer reason: When opioids are ineffective and the client is stable, pain management requires **provider-guided titration** to reach therapeutic effect. Administering extra doses without an order is unsafe, and withholding titration prolongs suffering.

Question 47

A postoperative client receives acetaminophen, a low-dose opioid, and a regional nerve block. The client asks why so many different types of pain treatments are needed. What is the nurse’s best explanation?

Accepted Answer

Answer reason: Multimodal pain therapy uses **different analgesic mechanisms** to enhance relief while minimizing opioid requirements and side effects. This is evidence-based and improves outcomes.

Question 48

An 82-year-old client with chronic pain is prescribed an opioid. Which nursing action is most important to reduce risk of adverse effects?

Accepted Answer

Answer reason: Older adults have reduced clearance and increased sensitivity to opioids. **Start low, go slow** is the safety principle—with close monitoring for CNS depression, confusion, and falls.

Question 49

A client using a transdermal fentanyl patch for chronic cancer pain reports that the patch “isn’t working as well today.” The nurse notes that the patch is still in place but the client has a low-grade fever. What is the nurse’s best response?

Accepted Answer

Answer reason: Heat and fever both increase peripheral vasodilation, which **raises fentanyl absorption** from transdermal patches. This can lead to toxicity (sedation, confusion, respiratory depression). The nurse must assess first—not increase dose or add heat.

Question 50

A client receiving scheduled opioid therapy reports constipation despite increasing fluid intake. Which intervention should the nurse implement to manage opioid-related constipation most effectively?

Accepted Answer

Answer reason: Opioid-induced constipation does **not** improve with time and requires a **scheduled bowel regimen**, typically including stimulant laxatives or stool softeners. Fluid/fiber alone is insufficient, and dose reduction cannot be done without provider direction.

Train with a large NCLEX question bank and jump into a full exam-style simulator

Pharmacological Pain Management NCLEX Practice Test

Continue Learning