CRRN Pain Management in Rehabilitation Nursing 1 — 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.
CRRN Pain Management in Rehabilitation Nursing 1
Which pain assessment tool is most appropriate for evaluating pain in a non-verbal adult patient with cognitive impairment in a rehabilitation setting?