Sudden severe pain, new chest pain, or pain out of proportion to an injury (possible compartment syndrome) — assess and notify the provider now.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is caring for a nonverbal client with advanced dementia who appears to be in pain. Which assessment approach is most appropriate?
Answer: A. When a client cannot self-report, the nurse uses a validated behavioral observation tool such as PAINAD, which scores breathing, vocalization, facial expression, body language, and consolability. Behavioral cues become the primary indicator of pain.
Question 2 of 5
A nurse evaluates the effectiveness of a pain intervention. When should the nurse reassess pain after administering an IV opioid?
Answer: A. IV opioids reach peak effect within roughly 15 to 30 minutes, so the nurse reassesses pain about 15 to 30 minutes after IV administration. Oral analgesics are typically reassessed around 60 minutes. Reassessment confirms effectiveness and guides further action.
Question 3 of 5
A nurse is assessing a client's pain. Which statement reflects the most accurate principle of pain assessment?
Answer: A. Pain is subjective; the single most reliable indicator is the client's self-report. The nurse should accept and act on the client's report rather than judging it against objective signs.
Question 4 of 5
A hospice client has increasing pain near the end of life. The nurse's approach to pain is to:
Answer: B. In hospice/palliative care, the priority is comfort — titrate opioids/analgesics to relieve pain even if it may have side effects (the principle of double effect), and address total comfort. Withholding pain medication out of fear of addiction is inappropriate at end of life.
Question 5 of 5
A nurse is performing a dressing change on a deep partial-thickness burn. The procedure is very painful for the client. Which nursing action best addresses the pain?
Answer: A. Burn dressing changes are among the most painful procedures. The nurse should administer the prescribed analgesic, often an IV opioid, and time the dressing change to coincide with its peak effect. Nonpharmacologic measures such as distraction supplement but do not replace analgesia. Withholding pain medication or rushing the procedure without analgesia is inappropriate.
Keep the streak going with more questions like these, each with a full rationale.
What is pain assessment (pqrst)?
PQRST gives the assessment a fixed order: what Provokes or relieves it, its Quality, the Region and whether it Radiates, its Severity on a 0–10 scale, and its Timing. A structured assessment lets the nurse compare findings across shifts, judge whether an intervention worked, and spot a new or changed pain that needs escalation. When a patient cannot self-report, a validated behavioral scale replaces the numeric rating.
Key points to remember
- Provocation and palliation: ask what started the pain, what makes it worse, and what eases it (position, heat, rest, medication).
- Quality: let the patient describe it in their own words (sharp, dull, burning, crushing, stabbing); burning or shooting pain suggests a nerve cause.
- Region and radiation: have the patient point to it and ask whether it spreads; chest pain spreading to the jaw or left arm is treated as cardiac until proven otherwise.
- Severity: use the same scale every time — 0–10 numeric for adults, FACES for children about 3 and older, FLACC for infants and nonverbal children, PAINAD for advanced dementia.
- Timing: onset, duration, frequency, and whether it is constant or comes and goes; also ask how it affects sleep, movement and mood.
- Vital signs are not a reliable pain measure: chronic pain often comes with normal vital signs, and a quiet or sleeping patient may still be in pain.
Nursing priorities
- Assess pain on admission, at regular intervals, with every new report of pain, and after every intervention.
- Accept and document the patient's own rating, even when it does not match how they look.
- Reassess after treatment: about 15–30 minutes after an IV analgesic and 30–60 minutes after an oral one.
- Combine medication with nondrug measures (positioning, ice or heat, distraction) and time doses before painful activities.
- Check sedation level and respiratory rate before and after giving an opioid.
Patient teaching
- Report pain early, before it becomes severe; it is easier to control.
- Use the same 0–10 scale each time so changes can be tracked.
- Tell the nurse if a medicine is not working or causes nausea, itching or drowsiness.
Red flags: report now
- Sudden severe pain, new chest pain, or pain out of proportion to an injury (possible compartment syndrome) — assess and notify the provider now.
- Increasing sedation or a respiratory rate below 12/min after an opioid — stop the opioid, stimulate the patient, and prepare naloxone per protocol.
- Never assume a calm, sleeping or smiling patient is pain-free; assess with the right scale.
References
Clinical references for this topic
