PROPHECY CORE MANDATORY PART III NURSING WINTER
2026/2027 | Answered Updated Guide | Complete Q&A |
Pass Guaranteed - A+ Graded
[Section 1: Pain Management & Opioid Safety (Q1-12)]
Pain Assessment Tools (Numeric, Wong-Baker, PAINAD) | Multimodal Analgesia | Opioid
Risk Assessment (SOAPP-R, ORT) | Naloxone Administration (0.4mg IM/Nasal) | PCA
Safety (Respiratory rate <8-10, sedation score) | Equianalgesic Dosing Conversions
Q1. A 78-year-old patient with advanced dementia is post-op day 2 after hip fracture
repair. The patient is nonverbal and grimaces with movement. Which pain assessment
tool is most appropriate for this patient?
A. Numeric Rating Scale (NRS) 0-10
B. Wong-Baker FACES Pain Rating Scale
C. PAINAD (Pain Assessment in Advanced Dementia) Scale
D. FLACC Scale (Face, Legs, Activity, Cry, Consolability)
Correct Answer: C
C. PAINAD (Pain Assessment in Advanced Dementia) Scale [CORRECT]
Rationale: The PAINAD scale is specifically validated for patients with advanced
dementia who are nonverbal. It assesses breathing, negative vocalization, facial
expression, body language, and consolability on a 0-10 scale. A is incorrect because NRS
requires self-report. B is incorrect because Wong-Baker requires cognitive ability to
match faces to pain intensity. D is incorrect because FLACC is primarily validated for
infants and young children, not adults with dementia. Prophecy Pearl: The PAINAD is
the go-to tool for nonverbal adults with cognitive impairment—know this distinction
cold for the exam.
,Q2. A patient rates their pain as 8/10 on the Numeric Rating Scale and requests
medication. Thirty minutes after receiving IV morphine 4mg, the patient reports pain as
3/10. According to 2026 CDC acute pain guidelines, what is the nurse's next priority
action?
A. Administer a scheduled dose of acetaminophen 1000mg PO now
B. Reassess pain, respiratory rate, and sedation level in 15 minutes
C. Document the 50% reduction in pain as a successful intervention
D. Notify the provider that the opioid was ineffective
Correct Answer: B
B. Reassess pain, respiratory rate, and sedation level in 15 minutes [CORRECT]
Rationale: The 2026 CDC guidelines emphasize that reassessment after IV opioids must
occur within 15-30 minutes and must include respiratory rate and sedation level—not
just pain score. A is incorrect because adding another analgesic without full
reassessment could oversedate. C is incorrect because documentation alone without
reassessment of respiratory status is unsafe; opioid-induced respiratory depression can
occur even with adequate analgesia. D is incorrect because a 5-point reduction (62.5%
improvement) is clinically significant and does not indicate treatment failure. Prophecy
Pearl: The exam consistently traps nurses who think "pain reassessment" means only
asking about pain—always include respiratory rate and sedation for IV opioids.
Q3. A nurse is caring for a patient with chronic non-cancer back pain who has been on
oxycodone 10mg PO q6h for 3 months. The provider wants to transition the patient to a
multimodal approach. Based on 2026 CDC guidelines for chronic non-cancer pain, which
statement by the nurse is most appropriate?
A. "Non-opioid therapies are preferred as first-line for chronic non-cancer pain, and we
should discuss options like physical therapy and NSAIDs."
B. "Since you've been stable on opioids for 3 months, continuing long-term opioid
therapy is the safest option."
,C. "We need to increase your opioid dose because you've developed tolerance."
D. "Opioids are completely contraindicated for any type of chronic pain."
Correct Answer: A
A. "Non-opioid therapies are preferred as first-line for chronic non-cancer pain, and we
should discuss options like physical therapy and NSAIDs." [CORRECT]
Rationale: The 2026 CDC guidelines explicitly state that non-opioid therapies are
preferred for chronic non-cancer pain, and opioids should be used only when benefits
outweigh risks, with the lowest effective dose. B is incorrect because stability for 3
months does not justify indefinite opioid use without exploring alternatives. C is
incorrect because tolerance does not automatically warrant dose escalation; it signals
the need for reassessment and multimodal strategies. D is incorrect because opioids are
not absolutely contraindicated—they are reserved for specific situations where non-
opioids fail. Prophecy Pearl: The CDC guideline shift toward non-opioid preference is a
high-yield testing point; "preferred" does not mean "prohibited."
Q4. Before initiating long-term opioid therapy for a patient with chronic low back pain,
the nurse is reviewing the patient's opioid risk assessment. The patient has a history of
depression, a family history of substance use disorder, and occasionally takes more
medication than prescribed. Which assessment tool is most appropriate to quantify this
patient's risk?
A. Numeric Rating Scale (NRS)
B. SOAPP-R (Screener and Opioid Assessment for Patients with Pain-Revised)
C. PAINAD Scale
D. COWS (Clinical Opiate Withdrawal Scale)
Correct Answer: B
B. SOAPP-R (Screener and Opioid Assessment for Patients with Pain-Revised)
[CORRECT]
Rationale: SOAPP-R is a validated 24-item tool specifically designed to assess risk of
aberrant medication-related behaviors in patients being considered for long-term
opioid therapy. A is incorrect because NRS measures pain intensity, not risk. C is
, incorrect because PAINAD assesses pain in nonverbal patients with dementia. D is
incorrect because COWS assesses opioid withdrawal severity, not risk for misuse.
Prophecy Pearl: Know the difference between SOAPP-R (risk screening before starting
opioids) and ORT (Opioid Risk Tool, a brief 5-item screen); SOAPP-R is more
comprehensive and used when aberrant behaviors are suspected.
Q5. A patient receiving IV hydromorphone 1mg develops respiratory depression with a
respiratory rate of 6 breaths/minute and pinpoint pupils. The nurse prepares to
administer naloxone. What is the correct initial adult dose and route for this opioid-
induced respiratory emergency?
A. Naloxone 2mg IV push, repeat every 2 minutes as needed
B. Naloxone 0.4mg IM or intranasal, titrate to respiratory response
C. Naloxone 10mg IV bolus, single dose
D. Naloxone 0.1mg subcutaneous, may repeat once
Correct Answer: B
B. Naloxone 0.4mg IM or intranasal, titrate to respiratory response [CORRECT]
Rationale: The standard initial adult dose for naloxone in opioid-induced respiratory
depression is 0.4mg IM or intranasal (2mg/0.1mL spray, one spray in each nostril),
titrated to restore adequate respiratory effort without completely reversing analgesia. A
is incorrect because 2mg IV is excessive for initial dosing and risks precipitating severe
withdrawal and acute pain. C is incorrect because 10mg is a massive overdose that
would cause severe withdrawal, catecholamine surge, and potential cardiovascular
complications. D is incorrect because 0.1mg subcutaneous is subtherapeutic and
subcutaneous absorption is too slow for respiratory emergencies. Prophecy Pearl: The
exam tests whether you know to titrate naloxone to respiratory response, not to full
consciousness—over-reversal causes acute withdrawal and catecholamine storm.
Q6. A patient with cancer pain is using a morphine patient-controlled analgesia (PCA)
pump. The orders are: basal rate 1mg/hr, demand dose 1mg, lockout interval 10
2026/2027 | Answered Updated Guide | Complete Q&A |
Pass Guaranteed - A+ Graded
[Section 1: Pain Management & Opioid Safety (Q1-12)]
Pain Assessment Tools (Numeric, Wong-Baker, PAINAD) | Multimodal Analgesia | Opioid
Risk Assessment (SOAPP-R, ORT) | Naloxone Administration (0.4mg IM/Nasal) | PCA
Safety (Respiratory rate <8-10, sedation score) | Equianalgesic Dosing Conversions
Q1. A 78-year-old patient with advanced dementia is post-op day 2 after hip fracture
repair. The patient is nonverbal and grimaces with movement. Which pain assessment
tool is most appropriate for this patient?
A. Numeric Rating Scale (NRS) 0-10
B. Wong-Baker FACES Pain Rating Scale
C. PAINAD (Pain Assessment in Advanced Dementia) Scale
D. FLACC Scale (Face, Legs, Activity, Cry, Consolability)
Correct Answer: C
C. PAINAD (Pain Assessment in Advanced Dementia) Scale [CORRECT]
Rationale: The PAINAD scale is specifically validated for patients with advanced
dementia who are nonverbal. It assesses breathing, negative vocalization, facial
expression, body language, and consolability on a 0-10 scale. A is incorrect because NRS
requires self-report. B is incorrect because Wong-Baker requires cognitive ability to
match faces to pain intensity. D is incorrect because FLACC is primarily validated for
infants and young children, not adults with dementia. Prophecy Pearl: The PAINAD is
the go-to tool for nonverbal adults with cognitive impairment—know this distinction
cold for the exam.
,Q2. A patient rates their pain as 8/10 on the Numeric Rating Scale and requests
medication. Thirty minutes after receiving IV morphine 4mg, the patient reports pain as
3/10. According to 2026 CDC acute pain guidelines, what is the nurse's next priority
action?
A. Administer a scheduled dose of acetaminophen 1000mg PO now
B. Reassess pain, respiratory rate, and sedation level in 15 minutes
C. Document the 50% reduction in pain as a successful intervention
D. Notify the provider that the opioid was ineffective
Correct Answer: B
B. Reassess pain, respiratory rate, and sedation level in 15 minutes [CORRECT]
Rationale: The 2026 CDC guidelines emphasize that reassessment after IV opioids must
occur within 15-30 minutes and must include respiratory rate and sedation level—not
just pain score. A is incorrect because adding another analgesic without full
reassessment could oversedate. C is incorrect because documentation alone without
reassessment of respiratory status is unsafe; opioid-induced respiratory depression can
occur even with adequate analgesia. D is incorrect because a 5-point reduction (62.5%
improvement) is clinically significant and does not indicate treatment failure. Prophecy
Pearl: The exam consistently traps nurses who think "pain reassessment" means only
asking about pain—always include respiratory rate and sedation for IV opioids.
Q3. A nurse is caring for a patient with chronic non-cancer back pain who has been on
oxycodone 10mg PO q6h for 3 months. The provider wants to transition the patient to a
multimodal approach. Based on 2026 CDC guidelines for chronic non-cancer pain, which
statement by the nurse is most appropriate?
A. "Non-opioid therapies are preferred as first-line for chronic non-cancer pain, and we
should discuss options like physical therapy and NSAIDs."
B. "Since you've been stable on opioids for 3 months, continuing long-term opioid
therapy is the safest option."
,C. "We need to increase your opioid dose because you've developed tolerance."
D. "Opioids are completely contraindicated for any type of chronic pain."
Correct Answer: A
A. "Non-opioid therapies are preferred as first-line for chronic non-cancer pain, and we
should discuss options like physical therapy and NSAIDs." [CORRECT]
Rationale: The 2026 CDC guidelines explicitly state that non-opioid therapies are
preferred for chronic non-cancer pain, and opioids should be used only when benefits
outweigh risks, with the lowest effective dose. B is incorrect because stability for 3
months does not justify indefinite opioid use without exploring alternatives. C is
incorrect because tolerance does not automatically warrant dose escalation; it signals
the need for reassessment and multimodal strategies. D is incorrect because opioids are
not absolutely contraindicated—they are reserved for specific situations where non-
opioids fail. Prophecy Pearl: The CDC guideline shift toward non-opioid preference is a
high-yield testing point; "preferred" does not mean "prohibited."
Q4. Before initiating long-term opioid therapy for a patient with chronic low back pain,
the nurse is reviewing the patient's opioid risk assessment. The patient has a history of
depression, a family history of substance use disorder, and occasionally takes more
medication than prescribed. Which assessment tool is most appropriate to quantify this
patient's risk?
A. Numeric Rating Scale (NRS)
B. SOAPP-R (Screener and Opioid Assessment for Patients with Pain-Revised)
C. PAINAD Scale
D. COWS (Clinical Opiate Withdrawal Scale)
Correct Answer: B
B. SOAPP-R (Screener and Opioid Assessment for Patients with Pain-Revised)
[CORRECT]
Rationale: SOAPP-R is a validated 24-item tool specifically designed to assess risk of
aberrant medication-related behaviors in patients being considered for long-term
opioid therapy. A is incorrect because NRS measures pain intensity, not risk. C is
, incorrect because PAINAD assesses pain in nonverbal patients with dementia. D is
incorrect because COWS assesses opioid withdrawal severity, not risk for misuse.
Prophecy Pearl: Know the difference between SOAPP-R (risk screening before starting
opioids) and ORT (Opioid Risk Tool, a brief 5-item screen); SOAPP-R is more
comprehensive and used when aberrant behaviors are suspected.
Q5. A patient receiving IV hydromorphone 1mg develops respiratory depression with a
respiratory rate of 6 breaths/minute and pinpoint pupils. The nurse prepares to
administer naloxone. What is the correct initial adult dose and route for this opioid-
induced respiratory emergency?
A. Naloxone 2mg IV push, repeat every 2 minutes as needed
B. Naloxone 0.4mg IM or intranasal, titrate to respiratory response
C. Naloxone 10mg IV bolus, single dose
D. Naloxone 0.1mg subcutaneous, may repeat once
Correct Answer: B
B. Naloxone 0.4mg IM or intranasal, titrate to respiratory response [CORRECT]
Rationale: The standard initial adult dose for naloxone in opioid-induced respiratory
depression is 0.4mg IM or intranasal (2mg/0.1mL spray, one spray in each nostril),
titrated to restore adequate respiratory effort without completely reversing analgesia. A
is incorrect because 2mg IV is excessive for initial dosing and risks precipitating severe
withdrawal and acute pain. C is incorrect because 10mg is a massive overdose that
would cause severe withdrawal, catecholamine surge, and potential cardiovascular
complications. D is incorrect because 0.1mg subcutaneous is subtherapeutic and
subcutaneous absorption is too slow for respiratory emergencies. Prophecy Pearl: The
exam tests whether you know to titrate naloxone to respiratory response, not to full
consciousness—over-reversal causes acute withdrawal and catecholamine storm.
Q6. A patient with cancer pain is using a morphine patient-controlled analgesia (PCA)
pump. The orders are: basal rate 1mg/hr, demand dose 1mg, lockout interval 10
