1. Which statement indicates the development of opioid tolerance?

Larger doses of opioids are needed to control pain, compared to several weeks earlier.
Stimulants are needed to counteract the sedating effects of opioids.
The patient becomes anxious about knowing the exact time of the next dose of opioid.
The patient no longer experiences constipation from the usual dose of opioid.
2. The pain management nurse observes a patient with complex regional pain syndrome who is
not wearing the right-side jacket sleeve. The patient reports intense, right arm pain upon light
touch. The nurse recognizes this pain as:

allodynia.

hypoalgesia.

neuritis.

paresthesia.

3. A 45-year-old patient reports pain in the foot that moves up along the calf, saying: "My right
foot feels like it is on fire." The patient reports that the pain started yesterday and that he or she
has no previous history of injuries or falls. Which components of pain assessment has the
patient reported?

Aggravating and alleviating factors

Exacerbation, and associated signs and symptoms

Intensity, temporal characteristics, and functional impact

Location, quality, and onset

4. A 53-year-old patient who is receiving ibuprofen (Motrin), 400 mg twice a day for chronic, low
back pain develops lower extremity edema. The pain management nurse suspects that the
edema is caused by:

a decrease in renal function.

a low creatinine level.

an increase in glomerular filtration rate.

an increase in plasma proteins.

5. A distinguishing feature of a cluster headache is that it occurs:

bilaterally.
globally.
occipitally.
unilaterally.
6. A 73-year-old patient with cancer is in the hospital for pain control and rates pain as a “12” on
the Numeric Rating Scale of 0 to 10. Thirty minutes after receiving IV pain medication, the
patient reports no pain relief. The pain management nurse calls the physician for additional
orders for pain medication. The nurse's actions demonstrate:

analgesic titration.

empathy.

independence.

patient advocacy.

7. A 35-year-old, male patient with testicular cancer is joking and playing cards with his
roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on
the Numeric Rating Scale of 0 to 10. The nurse concludes that the patient's behavior:

is an emotional reaction to having cancer.

is in anticipation of future pain.

is more indicative of the need for pain medication than the pain rating.

may be in conflict with the pain rating, and accepts the report of pain.

8. An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for
neuropathic pain. Which statement indicates the patient's need for additional education?

“I will chew sugarless gum and mints.”

“I will drink carbonated beverages.”

“I will take my medication at breakfast.”

“I will use a humidifier at bedtime.”

9. Which nonpharmacologic intervention is difficult to use with older adults who are cognitively
impaired?

Aromatherapy

Distraction

Guided imagery

Heat application

10. An 85-year-old, male patient with a history of prostate cancer and metastasis to the lumbar
spine, is receiving methadone (Dolophine), 10 mg, three times a day. The patient's spouse tells
the pain management nurse that the patient exhibits a lack of motivation, loss of appetite, and
an inability to get out of bed. The nurse initially focuses on the patient's:
need for antidepressants.

pain assessment.

physical therapy evaluation.

psychological evaluation.

11. The pain management nurse assesses a patient with complex regional pain syndrome. The
nurse is concerned about the patient's depressed mood, because she or he has said: "I can't live
with this pain." The nurse further assesses for suicide risk, because:

decreased pain thresholds lead to suicidal thoughts.

suicidal thoughts are common in patients with chronic pain.

suicidal thoughts are often expressed by patients with acute pain.

verbalization of suicidal thoughts is a way for patients to get attention.

12. A 45-year-old patient is diagnosed with lumbar radiculopathy. The patient's pain is not well
controlled by an opioid medication. Which medication class does the pain management nurse
identify as being the first-line, adjuvant medication for this diagnosis?

Acetaminophen-containing drugs

Nonsteroidal antiinflammatory drugs

Serotonin reuptake inhibitor antidepressants

Tricyclic antidepressants

13. Biofeedback is a therapy used to:

develop psycho-physiologic self-regulation.

enhance drug delivery.

increase release of serotonin.

promote neuronal regeneration.

14. Which question does the pain management nurse ask a patient who is taking chondroitin, to
prevent potential drug interactions?

“Are you a smoker?”

“Do you have a history of anemia?”

“Do you have diabetes and take insulin?”

“Do you take prescribed blood thinners or aspirin?”

15. The pain management nurse assesses a 67-year-old patient for reports of episodic, sudden
onset, right-sided facial pain. The patient describes the pain as fleeting, electric-like, and
triggered by light touch and brushing of the teeth. The nurse suspects:

facet syndrome.

myofascial pain syndrome.

temporomandibular disorder.

trigeminal neuralgia.

16. When assessing an infant for pain, the pain management nurse recognizes that:

a lack of a physiologic or behavioral response means a lack of pain.

if something causes pain in an adult, it can cause pain in an infant.

the parent's observations should not be included in the patient's assessment of pain.

Wong-Baker FACES Scale is an appropriate assessment tool.

17. Proxy pain ratings are used when the patient:

inconsistently provides pain ratings.

is hearing impaired.

is unable to provide pain ratings.

refuses to give a pain score.

18. A patient is utilizing a heating pad at home for the treatment of a muscle spasm. The pain
management nurse notes the patient is on a transdermal fentanyl (Duragesic) patch. What will
the nurse include in the patient's education?

Avoid using the heating pad directly over the patch

Cover the patch with a cloth while using the heating pad

Remove the patch while using the heating pad

Stop the use of the heating pad until the patch is discontinued

19. The main responsibilities of the nurse case manager on the interdisciplinary, chronic pain
management team are to:

assess level of function; design a therapeutic exercise plan; and monitor functional progress.

provide a comprehensive, psychosocial evaluation; implement cognitive behavior interventions;

and teach problem-solving techniques.
provide ergonomic training; develop pain management strategies to apply in the workplace;
and facilitate the return to work.

review the medical history; monitor medications; and provide education for the patient and
family.

20. The pain management nurse is assessing a trauma patient's readiness for discharge, by
determining the level of comfort the patient prefers. The nurse completes this portion of the
pain assessment by asking about the patient's:

aggravating and alleviating factors.

intensity of pain.

onset of pain.

pain goal.

21. A patient with fibromyalgia reports symptoms of unrelieved pain. To determine whether the
patient is also experiencing other conditions, the pain management nurse will ask the patient
about:

constipation, dizziness, and pruritus.

evening pain and stiffness.

hyperactivity, followed by periods of heavy sleep.

loss of appetite and increased feelings of anxiety.

22. A patient refuses to take acetaminophen (Tylenol), stating that it is like taking a sugar pill.
The pain management nurse explains that taking Tylenol, 650 mg, orally is equivalent to taking:

hydrocodone (Vicodin) 5 mg, orally.

ibuprofen (Motrin), 800 mg, orally.

morphine (MSIR), 1 mg, orally.

naproxen sodium (Aleve), 500 mg, orally.

23. The pain management nurse, concerned with metabolite accumulation in a patient with
decreased creatinine clearance, decides to utilize:

fentanyl.
meperidine (Demerol).
morphine.
oxycodone (Roxicodone).
24. A patient is receiving a continuous, upper extremity, peripheral nerve block, following
surgery to the left elbow. The pain management nurse immediately notifies the anesthesia
provider of:

a change in level of sensory or motor function to the left hand.

a new complaint of left great toe pain with a reported history of gout.
new orders written by the surgeon to increase frequency of oral oxycodone from every six
hours as needed, to every four hours as needed.
patient refusal to participate in physical therapy.
25. A 12-year-old oncology patient is in home care without IV access and needs medication for
breakthrough pain. The pain management nurse's most effective route of administration to
recommend is:

intranasal.
nebulized.
oral transmucosal.
transdermal.