Pain Management in Rehabilitation Nursing Flashcards

Which pain assessment tool is most appropriate for evaluating pain in a non-verbal adult patient with cognitive impairment in a rehabilitation setting?

Answer: PAINAD Scale

The PAINAD (Pain Assessment in Advanced Dementia) scale was specifically designed to assess pain in non-verbal patients who cannot self-report, using behavioral indicators such as breathing, vocalization, facial expression, body language, and consolability.

In the PQRST pain assessment mnemonic used in rehabilitation nursing, what does the letter 'P' represent?

Answer: Precipitating and palliating factors

In the PQRST mnemonic, 'P' stands for Precipitating and Palliating factors — what makes the pain better or worse — which helps direct both pharmacological and non-pharmacological interventions.

A rehabilitation patient describes pain as 'burning, shooting, and electric shock-like' that radiates along the arm following a nerve distribution. This pain is best classified as:

Answer: Neuropathic pain

Neuropathic pain arises from damage or dysfunction of the nervous system and is characteristically described as burning, shooting, tingling, or electric shock-like, often following a dermatomal or nerve distribution pattern.

A rehabilitation patient with a T6 spinal cord injury suddenly reports a severe pounding headache and diaphoresis above the level of injury along with worsening pain. The nurse's priority action is to:

Answer: Assess for and eliminate the triggering stimulus for autonomic dysreflexia

Sudden severe headache with diaphoresis above the level of injury in a patient with SCI at T6 or above is a hallmark presentation of autonomic dysreflexia, a medical emergency requiring immediate identification and removal of the noxious stimulus.

Undertreated chronic pain in a rehabilitation patient is most likely to result in which of the following outcomes?

Answer: Functional decline and development of depression

Undertreated pain interferes with participation in rehabilitation activities, disrupts sleep, and is strongly associated with depression and functional decline, all of which impede the rehabilitation process.

The rehabilitation nurse is using the Functional Pain Scale (FPS) to assess a patient. How does this scale differ from the standard Numeric Rating Scale (NRS)?

Answer: It incorporates the impact of pain on the patient's ability to function

The Functional Pain Scale differs from the NRS by combining pain intensity with its functional impact, rating both how much pain the patient has and how it affects their ability to tolerate and perform activities — critical information in a rehabilitation context.

A rehabilitation nurse notes that a patient's pain is consistently worse during morning physical therapy sessions and improves with rest and ice application. This pain pattern is most consistent with:

Answer: Musculoskeletal pain aggravated by mechanical loading

Pain that worsens with movement and physical loading during therapy but improves with rest and cryotherapy is characteristic of musculoskeletal pain, which is mechanical in nature and responds to activity modification and conservative interventions.

Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?

Answer: Anticonvulsants (gabapentinoids)

Anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica) are evidence-based first-line agents for neuropathic pain because they modulate calcium channels and reduce aberrant neuronal firing responsible for burning and shooting pain.

A rehabilitation patient is receiving scheduled opioid analgesics for moderate-to-severe pain. Which nursing assessment finding requires immediate intervention?

Answer: Respiratory rate of 8 breaths per minute with decreased arousal

Respiratory depression with decreased level of consciousness is the most life-threatening adverse effect of opioid analgesics and requires immediate intervention, including administration of naloxone (Narcan) and supportive care.

What is the maximum recommended daily dose of acetaminophen for a healthy adult patient in a rehabilitation setting?

Answer: 4,000 mg/day

The maximum recommended daily dose of acetaminophen for healthy adults is 4,000 mg/day; however, many clinicians and guidelines recommend limiting to 3,000 mg/day in elderly patients or those with liver disease risk to prevent hepatotoxicity.

A rehabilitation patient prescribed methadone for chronic pain management requires close monitoring because methadone:

Answer: Has a long and variable half-life that increases risk of accumulation

Methadone has a highly variable and prolonged half-life (8–59 hours) that can lead to drug accumulation and delayed respiratory depression, making careful dose titration and monitoring essential in rehabilitation settings.

A rehabilitation nurse is teaching a patient about the risks of long-term NSAID use. Which adverse effect is of greatest concern for patient safety?

Answer: Gastrointestinal bleeding and peptic ulcer formation

Long-term NSAID use inhibits prostaglandin synthesis, which reduces protective gastric mucosa production, significantly increasing the risk of gastrointestinal bleeding and peptic ulcer disease, especially in older rehabilitation patients.

Tricyclic antidepressants (TCAs) such as amitriptyline are sometimes prescribed for rehabilitation patients with chronic pain primarily because they:

Answer: Have demonstrated analgesic properties for neuropathic and central pain

TCAs have analgesic properties independent of their antidepressant effects, modulating norepinephrine and serotonin reuptake to inhibit pain signal transmission in the spinal cord, making them effective adjuvant analgesics for neuropathic pain.

A patient in rehabilitation is using a fentanyl transdermal patch for chronic pain management. Which instruction is most important for the nurse to include in patient education?

Answer: Apply the patch to a clean, dry, non-irritated flat skin surface

Fentanyl transdermal patches must be applied to clean, dry, non-irritated, flat skin to ensure consistent absorption; heat sources over the patch increase drug absorption and can cause fatal overdose due to accelerated fentanyl release.

Transcutaneous Electrical Nerve Stimulation (TENS) is believed to reduce pain in rehabilitation patients primarily through which mechanism?

Answer: Stimulating large-diameter nerve fibers to inhibit pain signal transmission via gate control theory

According to the gate control theory of pain, TENS works by activating large-diameter A-beta nerve fibers that compete with and inhibit the transmission of pain signals carried by smaller A-delta and C fibers at the level of the spinal cord dorsal horn.

Which non-pharmacological intervention is most appropriate for a rehabilitation patient experiencing acute musculoskeletal pain within the first 24 to 48 hours of injury?

Answer: Cold therapy (cryotherapy) applied to the injured area

Cold therapy (cryotherapy) is the preferred intervention in the acute phase of musculoskeletal injury because it causes vasoconstriction that reduces swelling, decreases inflammatory mediators, and produces local analgesia by slowing nerve conduction velocity.

A rehabilitation nurse is educating a patient with chronic pain about cognitive-behavioral therapy (CBT). The primary focus of CBT for pain management is to:

Answer: Identify and restructure maladaptive thought patterns and behaviors associated with pain

CBT for chronic pain targets the relationship between thoughts, emotions, and behaviors by teaching patients to identify catastrophizing and fear-avoidance beliefs and replace them with adaptive coping strategies that improve function despite pain.

A rehabilitation patient with chronic low back pain asks about biofeedback therapy. The nurse correctly explains that biofeedback helps manage pain by:

Answer: Teaching patients to consciously control physiological responses such as muscle tension and heart rate

Biofeedback provides real-time information about physiological functions such as muscle tension, skin temperature, or heart rate variability, enabling patients to learn voluntary control over these processes to reduce pain and stress responses.

A rehabilitation nurse is providing care for a patient with chronic pain who is using progressive muscle relaxation (PMR). PMR reduces pain primarily by:

Answer: Systematically tensing and releasing muscle groups to reduce overall muscle tension and anxiety

Progressive muscle relaxation involves deliberately tensing and then releasing specific muscle groups in sequence, which promotes awareness of tension and its release, decreasing overall musculoskeletal tension and the anxiety component of chronic pain.

Heat therapy (thermotherapy) is contraindicated in a rehabilitation patient with which condition?

Answer: Acute thrombophlebitis of the lower extremity

Heat therapy is contraindicated in acute thrombophlebitis because vasodilation from heat application can dislodge a thrombus, increasing the risk of pulmonary embolism; it is also contraindicated over areas with impaired sensation, malignancy, or open wounds.