CRRN Pain Management in Rehabilitation Nursing — Questions and Answers

Question 1: Which pain assessment tool is most appropriate for evaluating pain in a non-verbal adult patient with cognitive impairment in a rehabilitation setting?

Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)
PAINAD Scale (Correct answer)
Wong-Baker FACES Scale

Correct 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.

Question 2: In the PQRST pain assessment mnemonic used in rehabilitation nursing, what does the letter 'P' represent?

Pain level on a numeric scale
Precipitating and palliating factors (Correct answer)
Position of the patient during pain
Pharmacological history of the patient

Correct 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.

Question 3: 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:

Somatic pain
Visceral pain
Neuropathic pain (Correct answer)
Inflammatory pain

Correct 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.

Question 4: 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:

Administer a PRN analgesic immediately
Assess for and eliminate the triggering stimulus for autonomic dysreflexia (Correct answer)
Apply a heating pad to relieve muscle spasm
Notify dietary services about a potential food sensitivity

Correct 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.

Question 5: Undertreated chronic pain in a rehabilitation patient is most likely to result in which of the following outcomes?

Increased motivation for physical therapy participation
Improved quality of sleep and rest
Functional decline and development of depression (Correct answer)
Enhanced ability to perform activities of daily living

Correct 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.

Question 6: 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)?

It uses illustrated facial expressions to represent pain intensity
It is designed exclusively for pediatric rehabilitation patients
It incorporates the impact of pain on the patient's ability to function (Correct answer)
It only measures acute pain following surgical procedures

Correct 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.

Question 7: 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:

Neuropathic pain from nerve root compression
Visceral pain from an internal organ
Musculoskeletal pain aggravated by mechanical loading (Correct answer)
Central sensitization syndrome

Correct 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.

Question 8: Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?

Opioid analgesics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Anticonvulsants (gabapentinoids) (Correct answer)
Skeletal muscle relaxants

Correct 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.

Question 9: A rehabilitation patient is receiving scheduled opioid analgesics for moderate-to-severe pain. Which nursing assessment finding requires immediate intervention?

Mild constipation requiring a bowel regimen
Respiratory rate of 8 breaths per minute with decreased arousal (Correct answer)
Mild nausea after morning dose
Dry mouth reported during medication teaching

Correct 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.

Question 10: What is the maximum recommended daily dose of acetaminophen for a healthy adult patient in a rehabilitation setting?

2,000 mg/day
3,000 mg/day
4,000 mg/day (Correct answer)
6,000 mg/day

Correct 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.

Question 11: A rehabilitation patient prescribed methadone for chronic pain management requires close monitoring because methadone:

Has a short and predictable half-life of 2 to 4 hours
Is approved only for opioid use disorder and not for pain
Has a long and variable half-life that increases risk of accumulation (Correct answer)
Does not cause respiratory depression at therapeutic doses

Correct 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.

Question 12: 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?

Hyperkalemia leading to cardiac dysrhythmia
Gastrointestinal bleeding and peptic ulcer formation (Correct answer)
Hyperglycemia requiring insulin adjustment
Peripheral neuropathy causing sensory deficits

Correct 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.

Question 13: Tricyclic antidepressants (TCAs) such as amitriptyline are sometimes prescribed for rehabilitation patients with chronic pain primarily because they:

Work exclusively as antidepressants to improve mood and pain tolerance
Have demonstrated analgesic properties for neuropathic and central pain (Correct answer)
Significantly increase opioid receptor sensitivity to reduce opioid doses
Eliminate the need for participation in physical therapy

Correct 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.

Question 14: 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?

Apply the patch to a hairy area of skin to improve absorption
Change the patch every 12 hours for consistent pain control
Apply the patch to a clean, dry, non-irritated flat skin surface (Correct answer)
Applying a heating pad over the patch will not affect drug absorption

Correct 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.

Question 15: Transcutaneous Electrical Nerve Stimulation (TENS) is believed to reduce pain in rehabilitation patients primarily through which mechanism?

Increasing systemic cortisol release to suppress inflammation
Stimulating large-diameter nerve fibers to inhibit pain signal transmission via gate control theory (Correct answer)
Permanently blocking small-diameter nociceptive nerve fibers
Directly destroying peripheral pain receptors at the skin surface

Correct 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.

Question 16: Which non-pharmacological intervention is most appropriate for a rehabilitation patient experiencing acute musculoskeletal pain within the first 24 to 48 hours of injury?

Moist heat therapy applied for 20 minutes
Therapeutic ultrasound at deep tissue level
Cold therapy (cryotherapy) applied to the injured area (Correct answer)
Deep tissue massage over the acute injury site

Correct 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.

Question 17: 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:

Achieve complete elimination of all pain through psychological techniques alone
Identify and restructure maladaptive thought patterns and behaviors associated with pain (Correct answer)
Encourage total bed rest to prevent pain exacerbation during recovery
Replace all pharmacological pain management with psychological interventions

Correct 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.

Question 18: A rehabilitation patient with chronic low back pain asks about biofeedback therapy. The nurse correctly explains that biofeedback helps manage pain by:

Providing external electrical stimulation directly to the painful nerve roots
Teaching patients to consciously control physiological responses such as muscle tension and heart rate (Correct answer)
Using guided imagery to create a relaxation response that permanently eliminates pain
Administering subliminal auditory cues to block pain perception during therapy

Correct 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.

Question 19: A rehabilitation nurse is providing care for a patient with chronic pain who is using progressive muscle relaxation (PMR). PMR reduces pain primarily by:

Providing direct mechanical stimulation to pain receptors in muscle tissue
Systematically tensing and releasing muscle groups to reduce overall muscle tension and anxiety (Correct answer)
Applying external pressure to trigger points to release myofascial adhesions
Using controlled breathing patterns to increase oxygen delivery to painful tissues

Correct 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.

Question 20: Heat therapy (thermotherapy) is contraindicated in a rehabilitation patient with which condition?

Subacute low back strain more than one week post-injury
Chronic muscle spasm in the cervical region
Acute thrombophlebitis of the lower extremity (Correct answer)
Fibromyalgia with widespread musculoskeletal pain

Correct 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.

Question 21: Which non-pharmacological intervention is most appropriate and evidence-based for a rehabilitation patient experiencing phantom limb pain following lower extremity amputation?

Keeping the residual limb in a dependent position to reduce edema and pain
Applying a tight constrictive bandage to the residual limb around the clock
Mirror therapy combined with residual limb desensitization techniques (Correct answer)
Avoiding all tactile contact with the residual limb to prevent stimulation

Correct answer: Mirror therapy combined with residual limb desensitization techniques

Mirror therapy uses visual feedback of the intact limb's reflection to 'trick' the brain into perceiving the amputated limb as present and moving, which has demonstrated effectiveness in reducing phantom limb pain by reorganizing the cortical representation of the missing limb.

CRRN Pain Management in Rehabilitation Nursing

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

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