A 54-year-old woman is seen in a pain clinic 5 months after a right mastectomy. She describes burning and electric shock-like pain along the right chest wall and inner arm, and says even her bra strap touching the skin is painful. The incision is well healed with no redness. How should the nurse classify this pain?

Neuropathic pain from a peripheral nerve lesion

Nociplastic pain without any identifiable nerve injury

Visceral nociceptive pain referred to the chest wall

Somatic nociceptive pain from incisional healing

A 56-year-old woman with a history of episodic migraine comes to the emergency department with a severe headache that reached maximum intensity within 1 minute while she was lifting a box. She says it is the worst headache of her life. Which finding should the nurse treat as the PRIORITY concern?

The sudden thunderclap onset of the headache

Her nausea that began after the headache started

Her history of episodic migraine without aura

Her report that bright light worsens the pain

A 9-year-old boy is 6 hours after a laparoscopic appendectomy and rates his pain 7/10 on the Faces Pain Scale-Revised, guarding his abdomen and refusing to walk. Scheduled acetaminophen and ibuprofen are being given as ordered. His parents refuse the ordered oral oxycodone because they fear he will become addicted. Which response by the nurse is MOST appropriate?

Explain that short-term use for acute pain carries a low but real risk

Tell them that addiction cannot occur when a child has surgical pain

Document the refusal and recheck his pain at the next scheduled round

Give the oxycodone by mixing it into juice without telling the parents

A 47-year-old man with metastatic lung cancer takes oxycodone ER 40 mg orally every 12 hours. His pain is stable, but he has episodes of incident pain when he showers and dresses. The oncology nurse is helping plan a rescue order. Which breakthrough order is MOST appropriate?

Oxycodone IR 10 mg every 2 hours as needed

Oxycodone IR 40 mg every 12 hours as needed

Oxycodone IR 2.5 mg every 6 hours as needed

Oxycodone IR 30 mg every 4 hours as needed

A 71-year-old woman with chronic lumbar spinal stenosis is referred to the outpatient pain clinic for a home TENS unit. Before the nurse teaches electrode placement, which finding in her history requires clarification with the prescriber FIRST?

An implanted cardioverter-defibrillator placed 2 years ago

Daily use of acetaminophen 650 mg three times a day for back pain

A history of well-controlled hypertension managed with lisinopril

Mild osteoarthritis of both knees treated with topical diclofenac

A 58-year-old man is scheduled for a thoracotomy for lung resection. He has a history of anxiety and moderate preoperative chest wall pain. Which planning goal BEST addresses his risk of persistent postsurgical pain?

Aggressive multimodal and regional acute pain control

Opioid PCA alone with no other analgesic agents added

Delaying pain treatment until the drain is removed

Avoiding analgesics before surgery to assess baseline

A 61-year-old man with painful diabetic neuropathy has attended a self-management program for 6 weeks. Which statement BEST indicates he is using active coping strategies?

"I pace my yard work and use breathing exercises when pain flares."

"I take an extra pill whenever I feel that the pain is starting again."

"I lie down in a dark room and wait for the burning to finally pass."

"I rely on my wife to handle everything until the doctor fixes this."

A 63-year-old woman with metastatic breast cancer receives hospice care at home. The hospice nurse reviews her medication record for the past 3 days; pain is controlled only after rescue doses and she has no sedation. Medication Order Doses used per day Morphine ER 30 mg Every 12 hours, scheduled 2 each day Morphine IR 10 mg Every 2 hours as needed 4, 4 and 4 Which new scheduled morphine ER dose should the nurse recommend to the hospice physician?

Morphine ER 50 mg every 12 hours

Morphine ER 45 mg every 12 hours

Morphine ER 30 mg every 8 hours

Morphine ER 60 mg every 12 hours

A 72-year-old woman with chronic low back pain asks the pain clinic nurse whether she can begin chiropractic spinal manipulation, which helped her friend. Which finding in her history is the MOST important reason to advise against it?

Severe osteoporosis with a prior vertebral compression fracture

A history of mild seasonal allergies treated with loratadine daily

Use of acetaminophen 1 g twice daily for her chronic back pain

Previous benefit from a course of physical therapy for her knees

Pain Management Nursing Exam

Free Pain Management Nursing Practice Questions

10 sample questions for the Pain Management Nursing Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Pain Science, Mechanisms and Theories, Regional Analgesia, Interventional Procedures and Complications, Ethics, Standards, Regulation and Crisis Response.

Question 1 · Pain Science, Mechanisms and Theories
A 54-year-old woman is seen in a pain clinic 5 months after a right mastectomy. She describes burning and electric shock-like pain along the right chest wall and inner arm, and says even her bra strap touching the skin is painful. The incision is well healed with no redness. How should the nurse classify this pain?
- A.Nociplastic pain without any identifiable nerve injury
- B.Visceral nociceptive pain referred to the chest wall
- C.Neuropathic pain from a peripheral nerve lesion
- D.Somatic nociceptive pain from incisional healing
Show answer and explanation
Answer: C. Neuropathic pain from a peripheral nerve lesion
Burning, shooting and electric descriptors plus allodynia in a nerve distribution after surgery point to neuropathic pain from injury to the intercostobrachial or other peripheral nerves, a common cause of persistent post-mastectomy pain. Somatic incisional pain is aching and localized and should resolve as tissue heals. Nociplastic pain is diagnosed when there is no evidence of tissue damage or a nerve lesion, which does not fit this surgical history.
Question 2 · Pain Science, Mechanisms and Theories
A 56-year-old woman with a history of episodic migraine comes to the emergency department with a severe headache that reached maximum intensity within 1 minute while she was lifting a box. She says it is the worst headache of her life. Which finding should the nurse treat as the PRIORITY concern?
- A.Her nausea that began after the headache started
- B.The sudden thunderclap onset of the headache
- C.Her history of episodic migraine without aura
- D.Her report that bright light worsens the pain
Show answer and explanation
Answer: B. The sudden thunderclap onset of the headache
A thunderclap headache that peaks within about a minute is a red flag for subarachnoid hemorrhage and needs emergent evaluation regardless of a migraine history. Photophobia and nausea occur with both migraine and serious secondary headaches, so they do not distinguish the cause. A prior migraine history can falsely reassure clinicians and delay diagnosis.
Question 3 · Pain Science, Mechanisms and Theories
A 9-year-old boy is 6 hours after a laparoscopic appendectomy and rates his pain 7/10 on the Faces Pain Scale-Revised, guarding his abdomen and refusing to walk. Scheduled acetaminophen and ibuprofen are being given as ordered. His parents refuse the ordered oral oxycodone because they fear he will become addicted. Which response by the nurse is MOST appropriate?
- A.Tell them that addiction cannot occur when a child has surgical pain
- B.Explain that short-term use for acute pain carries a low but real risk
- C.Document the refusal and recheck his pain at the next scheduled round
- D.Give the oxycodone by mixing it into juice without telling the parents
Show answer and explanation
Answer: B. Explain that short-term use for acute pain carries a low but real risk
Fear of addiction is a common family barrier; the nurse gives accurate information that short, monitored use for acute pain carries a low but not zero risk, explains the harms of unrelieved pain, and partners with the parents on the plan. Saying addiction cannot occur is false, and covert administration violates their consent. Simply documenting and waiting leaves the child in uncontrolled pain without addressing the misconception.
Question 4 · Regional Analgesia, Interventional Procedures and Complications
A 47-year-old man with metastatic lung cancer takes oxycodone ER 40 mg orally every 12 hours. His pain is stable, but he has episodes of incident pain when he showers and dresses. The oncology nurse is helping plan a rescue order. Which breakthrough order is MOST appropriate?
- A.Oxycodone IR 40 mg every 12 hours as needed
- B.Oxycodone IR 2.5 mg every 6 hours as needed
- C.Oxycodone IR 30 mg every 4 hours as needed
- D.Oxycodone IR 10 mg every 2 hours as needed
Show answer and explanation
Answer: D. Oxycodone IR 10 mg every 2 hours as needed
The 24-hour oxycodone dose is 40 mg x 2 = 80 mg, and a breakthrough dose is about 10-20% of that total: 80 x 0.1 = 8 mg to 80 x 0.2 = 16 mg, so 10 mg is a practical dose, offered as often as every 2 hours (the oral peak). A 2.5 mg dose every 6 hours is far below 10% and too infrequent, and 30 or 40 mg doses exceed 20% of the daily total and raise sedation risk.
Question 5 · Regional Analgesia, Interventional Procedures and Complications
A 71-year-old woman with chronic lumbar spinal stenosis is referred to the outpatient pain clinic for a home TENS unit. Before the nurse teaches electrode placement, which finding in her history requires clarification with the prescriber FIRST?
- A.Daily use of acetaminophen 650 mg three times a day for back pain
- B.A history of well-controlled hypertension managed with lisinopril
- C.An implanted cardioverter-defibrillator placed 2 years ago
- D.Mild osteoarthritis of both knees treated with topical diclofenac
Show answer and explanation
Answer: C. An implanted cardioverter-defibrillator placed 2 years ago
TENS works through the gate control mechanism, but its electrical current can interfere with cardiac pacemakers and implanted defibrillators, so its use in these patients requires clearance from the prescriber or cardiology. Osteoarthritis, acetaminophen use and controlled hypertension are not contraindications. Other sites to avoid include the anterior neck over the carotid sinus, the eyes, broken skin and the pregnant uterus outside of labor.
Question 6 · Pain Science, Mechanisms and Theories
A 76-year-old woman has a fractured left femur after a fall. She describes a constant, throbbing, aching pain that she can point to precisely at the mid-thigh, and it worsens with any movement. How should the nurse classify this pain?
- A.Visceral nociceptive pain
- B.Nociplastic pain
- C.Central neuropathic pain
- D.Somatic nociceptive pain
Show answer and explanation
Answer: D. Somatic nociceptive pain
Somatic nociceptive pain arises from bone, joint, muscle or skin and is well localized, aching and throbbing, worse with movement, which fits a femur fracture. Visceral pain is poorly localized, cramping and often referred. Neuropathic pain has burning or electric qualities from a nerve lesion, and nociplastic pain occurs without clear tissue damage.
Question 7 · Pain Science, Mechanisms and Theories
A 58-year-old man is scheduled for a thoracotomy for lung resection. He has a history of anxiety and moderate preoperative chest wall pain. Which planning goal BEST addresses his risk of persistent postsurgical pain?
- A.Opioid PCA alone with no other analgesic agents added
- B.Aggressive multimodal and regional acute pain control
- C.Delaying pain treatment until the drain is removed
- D.Avoiding analgesics before surgery to assess baseline
Show answer and explanation
Answer: B. Aggressive multimodal and regional acute pain control
Thoracotomy carries a high risk of chronic postsurgical pain, and risk factors include preoperative pain, anxiety and severe acute postoperative pain; effective multimodal analgesia with regional techniques such as paravertebral or epidural blocks may reduce that transition. Withholding or delaying analgesia raises the risk. Opioid-only plans miss the benefit of combining agents acting at different sites.
Question 8 · Pain Science, Mechanisms and Theories
A 61-year-old man with painful diabetic neuropathy has attended a self-management program for 6 weeks. Which statement BEST indicates he is using active coping strategies?
- A."I pace my yard work and use breathing exercises when pain flares."
- B."I take an extra pill whenever I feel that the pain is starting again."
- C."I lie down in a dark room and wait for the burning to finally pass."
- D."I rely on my wife to handle everything until the doctor fixes this."
Show answer and explanation
Answer: A. "I pace my yard work and use breathing exercises when pain flares."
Active coping means the person takes purposeful steps to manage pain, such as pacing and relaxation skills, and is linked to better function and self-efficacy. Withdrawing to wait it out, depending on others or on a clinician to fix the pain, and taking unplanned extra doses are passive strategies associated with more disability. The nurse reinforces his active strategies at follow-up.
Question 9 · Regional Analgesia, Interventional Procedures and Complications
A 63-year-old woman with metastatic breast cancer receives hospice care at home. The hospice nurse reviews her medication record for the past 3 days; pain is controlled only after rescue doses and she has no sedation.
Medication Order Doses used per day
Morphine ER 30 mg Every 12 hours, scheduled 2 each day
Morphine IR 10 mg Every 2 hours as needed 4, 4 and 4
Which new scheduled morphine ER dose should the nurse recommend to the hospice physician?
- A.Morphine ER 45 mg every 12 hours
- B.Morphine ER 30 mg every 8 hours
- C.Morphine ER 50 mg every 12 hours
- D.Morphine ER 60 mg every 12 hours
Show answer and explanation
Answer: C. Morphine ER 50 mg every 12 hours
She regularly needs more than 2-3 rescue doses daily, so the 24-hour rescue total is added to the basal dose: ER 30 mg x 2 = 60 mg plus IR 10 mg x 4 = 40 mg, for 100 mg per day, or 50 mg every 12 hours. Her rescue dose should then be about 10-20% of 100 mg, or 10 to 20 mg. Thirty milligrams every 8 hours gives only 90 mg, 45 mg every 12 hours gives 90 mg, and 60 mg every 12 hours gives 120 mg.
Question 10 · Regional Analgesia, Interventional Procedures and Complications
A 72-year-old woman with chronic low back pain asks the pain clinic nurse whether she can begin chiropractic spinal manipulation, which helped her friend. Which finding in her history is the MOST important reason to advise against it?
- A.A history of mild seasonal allergies treated with loratadine daily
- B.Use of acetaminophen 1 g twice daily for her chronic back pain
- C.Severe osteoporosis with a prior vertebral compression fracture
- D.Previous benefit from a course of physical therapy for her knees
Show answer and explanation
Answer: C. Severe osteoporosis with a prior vertebral compression fracture
Spinal manipulation can benefit some patients with low back pain, but it is avoided in severe osteoporosis, cancer in the spine and spinal cord compression because of fracture and neurologic injury risk. Acetaminophen use, seasonal allergies and past response to physical therapy are not contraindications. The nurse can suggest safer options such as gentle exercise, tai chi or physical therapy.

Medication	Order	Doses used per day
Morphine ER 30 mg	Every 12 hours, scheduled	2 each day
Morphine IR 10 mg	Every 2 hours as needed	4, 4 and 4

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