Question 1

Which of the following nursing diagnoses is most appropriate for a patient experiencing pain?

Accepted Answer

Answer reason: The most appropriate nursing diagnosis for a patient experiencing pain is "Acute pain," which directly addresses the patient’s current problem and guides immediate interventions. The other options may be relevant depending on assessment findings (e.g., wounds, infection risk, knowledge deficits), but they do not specifically identify the pain as the primary issue. Naming the pain diagnosis supports targeted pain assessment, timely analgesic/nonpharmacologic interventions, and evaluation of response.

Question 2

A client with lung cancer is admitted with severe pain. Which pharmacological intervention should the nurse anticipate to manage severe pain effectively?

Accepted Answer

Answer reason: Severe cancer-related pain is best managed with an opioid analgesic, and morphine is a standard first-line strong opioid for severe pain. NSAIDs and acetaminophen are appropriate for mild-to-moderate pain or as adjuvants but are usually insufficient alone for severe pain. Benzodiazepines treat anxiety/muscle spasm and can provide sedation but are not analgesics and should not be used as the primary treatment for severe pain.

Question 3

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: Vaso-occlusive pain in sickle cell crisis is severe and requires prompt, adequate analgesia; apparent comfort or distraction does not rule out significant pain. Giving a placebo is unethical and violates pain-management standards. Increasing fluids and relaxation may be helpful adjuncts, but they do not address acute severe pain as the priority intervention. Timely analgesic administration supports comfort, reduces physiologic stress, and aligns with evidence-based management of sickle cell crisis.

Question 4

A nursing planning care for a school-age child who is 4 hr postoperative following perforated appendicitis. Which of the following actions should the nurse include in the plan of care?

Accepted Answer

Answer reason: In the immediate postoperative period after perforated appendicitis, effective pain control supports deep breathing, coughing, and early mobilization, which reduces respiratory complications and promotes recovery. Scheduled dosing maintains therapeutic levels and prevents pain escalation that can be harder to control once severe. The other options are either not standard immediate priorities for this situation (routine bronchodilator use without indication, warming a fresh incision), or are not as universally appropriate as proactive postoperative analgesia.

Question 5

A client who is in hospice care complains of increasing amounts of pain. The healthcare provider prescribes an analgesic every four hours as needed. Which action should the nurse implement?

Accepted Answer

Answer reason: In hospice care, escalating pain is best controlled with scheduled dosing to maintain steady analgesic levels and prevent pain from recurring, rather than waiting until pain becomes severe. PRN-only dosing can lead to peaks and troughs, delayed relief, and higher total distress for the client. Sedation is not the primary goal; the priority is comfort with the least impairment while respecting end-of-life goals. Regularly scheduled dosing can still allow for additional breakthrough doses if needed.

Question 6

Pain scale of 5 out of 10, what medication will you give?

Accepted Answer

Answer reason: A pain score of 5/10 is typically managed initially with a non-opioid such as acetaminophen, assuming no contraindications and with appropriate dosing limits to avoid hepatotoxicity. Opioids like morphine are generally excessive at this pain level due to higher risks of respiratory depression, sedation, and dependence. Combination therapy with tramadol or use of codeine introduces opioid-related adverse effects and is usually considered only if non-opioids are insufficient or specific clinical circumstances warrant escalation.

Question 7

The nurse is caring for a client with a 27% total body surface area burn. The burns are a combination of second and third-degree. Prior to the prescribed dressing change, the nurse should administer which medication?

Accepted Answer

Answer reason: An IV opioid provides the quickest and most reliable onset for short-term intense pain compared with oral agents. Extended-release oxycodone has delayed onset and is inappropriate for immediate procedural analgesia. A fentanyl patch is for chronic baseline pain and is unsafe/ineffective for rapid procedural pain control, and ketorolac alone is typically insufficient for severe burn pain and may add bleeding/renal risk in a large-burn patient.

Question 8

The client who has renal cancer that has metastasized rates pain at a 9 on a 0 to 10 pain scale. Which medication should the nurse plan to administer now and then schedule to be administered at the prescribed dosing interval?

Accepted Answer

Answer reason: This option is an appropriate full opioid agonist commonly used for ongoing control of moderate-to-severe malignant pain. Several alternatives listed are poor choices for chronic cancer pain: meperidine has a neurotoxic metabolite that can accumulate (especially concerning with renal impairment), propoxyphene is avoided due to unfavorable safety/efficacy, and pentazocine is a mixed agonist-antagonist that can precipitate withdrawal and has a ceiling effect on analgesia. Scheduling an effective opioid at regular intervals supports continuous pain control rather than reactive PRN-only dosing.

Question 9

The nurse is planning interventions for a client with an acute gout attack. What would the priority intervention for this client be?

Accepted Answer

Answer reason: Acute gout produces intense inflammatory joint pain, so immediate pain control and reduction of inflammation are the top priority to improve function and decrease physiologic stress. Giving ordered analgesics/anti-inflammatories (e.g., NSAIDs, colchicine, corticosteroids as prescribed) directly targets the acute symptoms and is time-sensitive. Bed rest and relaxation can be supportive but are not sufficient as the initial priority when severe pain is present. Increasing fluids may help reduce uric acid concentration and prevent stones, but it does not address the immediate acute pain and inflammation as effectively as medication.

Question 10

The nurse is reviewing the interventions listed in the plan of care for a child in vaso-occlusive crisis. What is the most important intervention for the nurse to implement?

Accepted Answer

Answer reason: Opioid and adjunct analgesia is a time-sensitive nursing action that directly addresses the primary, immediate problem and improves overall outcomes. Oxygen may be used if hypoxemic, but it is not universally indicated for every crisis and does not directly resolve the pain-driven stress response. Fluid restriction and encouraging activity are inappropriate because hydration is typically supported (not restricted) and rest is favored during acute painful episodes.

Question 11

A home-care nurse is following up with the client who was diagnosed with liver cancer 3 months ago. Which assessment information should the nurse communicate to the HCP?

Accepted Answer

Answer reason: Persistent moderate-to-severe cancer pain despite around-the-clock analgesics indicates inadequate pain control and the need to reassess the regimen for dose titration, opioid rotation, or addition of adjuvant therapies. This finding suggests the current plan is not meeting the goal of acceptable comfort and may also signal worsening disease or complications requiring provider evaluation. In home care, uncontrolled pain is a high-priority reportable assessment because it impacts function, safety, and quality of life and has clear actionable medical management steps. By comparison, unchanged weight and pruritus relieved by topical therapy are more stable findings, and generalized weakness/pallor may warrant follow-up but is less immediately actionable than severe uncontrolled pain on scheduled opioids.

Question 12

The client with Alzheimer’s dementia is being admitted to the nursing unit following a hip hemiarthroplasty to treat a hip fracture. Which initial intervention should the nurse plan for the client’s pain control?

Accepted Answer

Answer reason: Clients with Alzheimer’s dementia may have impaired ability to recognize, remember, or communicate pain, making PRN dosing based only on self-report unreliable and increasing the risk of undertreatment. Scheduled IV opioid dosing provides predictable analgesia during the immediate postoperative period when pain is expected to be significant, while allowing the nurse to monitor sedation and respiratory status closely. A PCA with a basal rate increases risk for opioid-induced respiratory depression and requires reliable patient participation, which may be unsafe in cognitive impairment. Transdermal fentanyl is not appropriate for acute postoperative pain due to slow onset and dosing concerns in opioid-naïve patients.

Question 13

A nurse plans care for a client admitted with a sickle cell crisis. After beginning hydration and oxygen supplementation, which is the priority intervention?

Accepted Answer

Answer reason: Vaso-occlusion in sickle cell crisis causes severe acute pain and increasing sympathetic stress, so rapid, adequately titrated analgesia is a priority after oxygenation and hydration are initiated. Patient-controlled analgesia supports timely opioid dosing, avoids delays in PRN administration, and improves pain control while allowing safer, smaller incremental doses with monitoring. Nutrition/weight support is important but is not immediately time-sensitive compared with uncontrolled pain and escalating physiologic stress. PT evaluation and depression screening are appropriate later once the acute crisis is stabilized.

Question 14

A client admitted to the emergency department with atrial fibrillation has a heart rate of 160 bpm. The nurse should implement which prescription first?

Accepted Answer

Answer reason: In atrial fibrillation with a rapid ventricular response (160 bpm), the immediate priority in a hemodynamically stable patient is rate control. Beta-blockers (e.g., metoprolol) slow AV node conduction and reduce ventricular rate, improving cardiac output and preventing further deterioration. Cardioversion is reserved for unstable patients, while anticoagulation (heparin) addresses thromboembolic risk but is not the first immediate intervention. Oxygen may be supportive but does not correct the underlying tachyarrhythmia.

Question 15

Which of the following analgesic should be administered to a patient with sickle cell anemia experiencing a vaso-occlusive crisis?

Accepted Answer

Answer reason: An IV opioid is the standard first-line choice when pain is moderate-to-severe, and this medication provides strong mu-opioid receptor analgesia appropriate for crisis-level pain. NSAIDs and acetaminophen may be used as adjuncts but are often insufficient alone for severe ischemic pain. NSAIDs also carry renal and bleeding risks, which is important because sickle cell disease can involve renal vulnerability and dehydration during crises.

Question 16

A client with pancreatitis is in acute pain. Which medication would the nurse anticipate using as the drug of first choice for this client?

Accepted Answer

Answer reason: This option is an appropriate first-line opioid because it provides strong analgesia and can be dosed IV and reassessed frequently based on effect and adverse reactions. The older teaching favoring meperidine to avoid sphincter of Oddi spasm is not supported as clinically meaningful and the drug has important risks (neurotoxic metabolite, seizures), so it is generally avoided. Codeine is too weak for severe acute pain and NSAIDs alone are often insufficient and may be limited by renal impairment, bleeding risk, or GI considerations in acutely ill patients.

Question 17

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

Accepted Answer

Answer reason: Progressive pancreatic cancer is strongly associated with severe, persistent visceral pain, so extended opioid use is appropriate and expected within a palliative/oncology plan. In contrast, fibromyalgia and neuropathic pain syndromes (phantom limb pain, trigeminal neuralgia) are typically treated first-line with non-opioid options such as antidepressants/anticonvulsants and nonpharmacologic therapies due to limited opioid benefit and higher risk. The cancer scenario most clearly matches sustained opioid prescribing with titration and bowel regimen monitoring.

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Pharmacological Pain Management Practice Test 2

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