Welcome, PharmD students, to this vital MCQ quiz on Patient Assessment for Pain and Fever! These common complaints drive many patients to seek advice from pharmacists. Your ability to effectively assess a patient’s pain or fever—using structured questioning to understand its characteristics, severity, and associated symptoms, and critically identifying when self-care is appropriate or when a medical referral is crucial—is fundamental to safe and effective patient care. This quiz will test your skills in gathering pertinent information and making sound clinical judgments for these prevalent conditions. Let’s begin!
1. When a patient complains of pain, which mnemonic is commonly used by pharmacists to comprehensively assess their symptoms?
- a) SOAP (Subjective, Objective, Assessment, Plan)
- b) PQRST (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing)
- c) ADME (Absorption, Distribution, Metabolism, Excretion)
- d) FAST (Face, Arms, Speech, Time – for stroke)
Answer: b) PQRST (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing)
2. In the PQRST pain assessment, “Q” stands for Quality. Which question best elicits this information?
- a) “When did the pain start?”
- b) “What does the pain feel like (e.g., sharp, dull, throbbing, burning)?”
- c) “On a scale of 0 to 10, how bad is your pain?”
- d) “What makes the pain worse?”
Answer: b) “What does the pain feel like (e.g., sharp, dull, throbbing, burning)?”
3. A patient describes a headache as bilateral, like a “tight band around the head,” with mild to moderate intensity and no nausea or vomiting. This is most characteristic of:
- a) Migraine headache
- b) Cluster headache
- c) Tension-type headache
- d) Sinus headache
Answer: c) Tension-type headache
4. Which of the following reported headache symptoms would be a “red flag” warranting immediate medical referral?
- a) Headache relieved by an OTC analgesic.
- b) Headache accompanied by fever and a stiff neck.
- c) Occasional mild headache after a stressful day.
- d) Headache lasting for 2 hours.
Answer: b) Headache accompanied by fever and a stiff neck. (Suggests meningitis)
5. When assessing musculoskeletal pain, it is important to ask about the mechanism of injury because:
- a) It determines the color of the bruise.
- b) It helps differentiate between acute injury (e.g., sprain, strain) and chronic conditions (e.g., osteoarthritis) and identify potential severity.
- c) It dictates whether an oral or topical analgesic should be used.
- d) It is not relevant for self-care assessment.
Answer: b) It helps differentiate between acute injury (e.g., sprain, strain) and chronic conditions (e.g., osteoarthritis) and identify potential severity.
6. A pain severity score of 8 on a 0-10 numeric rating scale is generally considered:
- a) Mild pain
- b) Moderate pain
- c) Severe pain, often an exclusion for self-treatment without prior diagnosis.
- d) No pain
Answer: c) Severe pain, often an exclusion for self-treatment without prior diagnosis.
7. When assessing a patient for fever, what is the most crucial piece of information regarding the temperature reading?
- a) The brand of the thermometer used.
- b) The actual measured temperature, the site of measurement (e.g., oral, rectal, axillary), and the time it was taken.
- c) The patient’s favorite color.
- d) Whether the patient feels warm.
Answer: b) The actual measured temperature, the site of measurement (e.g., oral, rectal, axillary), and the time it was taken.
8. Which method of temperature measurement is generally considered the most accurate reflection of core body temperature, especially in infants?
- a) Axillary (underarm)
- b) Oral
- c) Rectal
- d) Forehead (temporal artery) strip
Answer: c) Rectal
9. A rectal temperature of 100.4°F (38°C) or higher in an infant less than 3 months old is:
- a) Considered normal.
- b) A reason for immediate medical referral.
- c) Best treated with OTC ibuprofen.
- d) Indicative of teething only.
Answer: b) A reason for immediate medical referral.
10. When assessing a fever, it’s important to ask about associated symptoms. Which associated symptom would be a “red flag”?
- a) Mild fatigue.
- b) Decreased appetite.
- c) Presence of a non-blanching rash or unexplained bruising.
- d) Slightly runny nose.
Answer: c) Presence of a non-blanching rash or unexplained bruising.
11. The “T” in PQRST for pain assessment stands for Timing. This includes inquiring about:
- a) The type of pain medication used previously.
- b) The specific location of the pain.
- c) The onset, duration, and frequency of the pain (e.g., constant, intermittent).
- d) The severity of the pain.
Answer: c) The onset, duration, and frequency of the pain (e.g., constant, intermittent).
12. A patient reports pain in their knee that is worse with activity and relieved by rest, with morning stiffness lasting less than 30 minutes. This is suggestive of:
- a) Rheumatoid arthritis
- b) Osteoarthritis
- c) Gout
- d) A muscle strain
Answer: b) Osteoarthritis (Pharmacist assesses for self-care appropriateness).
13. An exclusion for self-treatment of pain is pain that has lasted longer than _______ days without medical evaluation (for many types of acute pain).
- a) 1-2 days
- b) 3-5 days
- c) 7-10 days
- d) 30 days
Answer: c) 7-10 days (Specific duration can vary by pain type and OTC product labeling).
14. When a patient complains of fever, asking “What have you already tried to treat the fever, and did it help?” helps to assess:
- a) The exact cause of the fever.
- b) The patient’s knowledge of antipyretics and the effectiveness of prior treatments.
- c) Their insurance coverage.
- d) Their preferred pharmacy.
Answer: b) The patient’s knowledge of antipyretics and the effectiveness of prior treatments.
15. Which of the following is an “alarm symptom” if present with a fever in an adult?
- a) Mild headache.
- b) Productive cough with clear sputum.
- c) Severe headache with stiff neck and confusion.
- d) Feeling slightly tired.
Answer: c) Severe headache with stiff neck and confusion. (Possible meningitis).
16. Using the SCHOLAR-MAC method for a patient with a headache, the “A” for Aggravating factors might include questions like:
- a) “What medications are you currently taking?”
- b) “Does light, noise, or movement make your headache worse?”
- c) “When did the headache start?”
- d) “What makes it feel better?”
Answer: b) “Does light, noise, or movement make your headache worse?”
17. Pain radiating down the arm or to the jaw, especially if accompanied by chest pressure or shortness of breath, is a critical red flag for:
- a) A tension headache.
- b) A potential myocardial infarction (heart attack) and requires emergency medical attention.
- c) Osteoarthritis of the shoulder.
- d) A minor muscle sprain.
Answer: b) A potential myocardial infarction (heart attack) and requires emergency medical attention.
18. Assessing a child’s behavior (e.g., playful vs. lethargic, irritable) is important when they have a fever because:
- a) It determines which antibiotic to use.
- b) A child who is very ill-appearing, regardless of the exact temperature, is more concerning and may need referral.
- c) Playful children never have serious illnesses.
- d) It helps choose the flavor of the medication.
Answer: b) A child who is very ill-appearing, regardless of the exact temperature, is more concerning and may need referral.
19. The “R” in PQRST for pain assessment stands for Region/Radiation. This involves asking the patient:
- a) “How severe is your pain?”
- b) “Where exactly is the pain, and does it spread anywhere else?”
- c) “What were you doing when the pain started?”
- d) “What makes the pain better?”
Answer: b) “Where exactly is the pain, and does it spread anywhere else?”
20. When assessing a patient for pain self-care, it is crucial to ask about their medication allergies and:
- a) Their favorite type of food.
- b) Their current medical conditions and all medications they are taking (Rx, OTC, herbals) to avoid interactions or contraindications.
- c) Their occupation.
- d) Their height and eye color.
Answer: b) Their current medical conditions and all medications they are taking (Rx, OTC, herbals) to avoid interactions or contraindications.
21. A fever lasting longer than _______ in an adult (without a clear self-limiting cause and not responding to self-care) generally warrants medical referral.
- a) 12 hours
- b) 24 hours
- c) 3 days
- d) 1 week
Answer: c) 3 days
22. A patient describes a headache as unilateral, throbbing, and associated with nausea, photophobia, and phonophobia. This pattern is highly suggestive of:
- a) Tension-type headache
- b) Sinus headache
- c) Migraine headache
- d) Medication-overuse headache
Answer: c) Migraine headache (Self-care is for mild-moderate, previously diagnosed migraine).
23. If a patient reports visual disturbances or neurological deficits (e.g., weakness, numbness) with their headache, the pharmacist should:
- a) Recommend an OTC analgesic and reassurance.
- b) Advise immediate medical evaluation.
- c) Suggest they try a higher dose of caffeine.
- d) Tell them to wait 24 hours to see if it resolves.
Answer: b) Advise immediate medical evaluation.
24. The primary goal of assessing a patient for pain or fever in a self-care context is to:
- a) Diagnose the underlying medical condition definitively.
- b) Determine if the patient is a candidate for safe and effective self-treatment or if they need to be referred to a physician.
- c) Persuade the patient to purchase the most expensive OTC product.
- d) Complete the consultation as quickly as possible.
Answer: b) Determine if the patient is a candidate for safe and effective self-treatment or if they need to be referred to a physician.
25. When a patient requests an OTC analgesic, asking “Who is this medication for?” is important because:
- a) It helps in choosing the right flavor.
- b) Dosing and product selection can differ significantly for adults, children, and infants.
- c) It determines the price.
- d) It’s just a polite conversation starter.
Answer: b) Dosing and product selection can differ significantly for adults, children, and infants.
26. A patient reports a fever of 101°F (38.3°C) and states they feel “chills and aches all over.” These accompanying symptoms are:
- a) Uncommon with fever.
- b) Common systemic symptoms that can occur with fever and help characterize the illness.
- c) Always indicative of a bacterial infection.
- d) Reasons to avoid all antipyretics.
Answer: b) Common systemic symptoms that can occur with fever and help characterize the illness.
27. What is a key question to ask a patient who frequently uses OTC analgesics for headaches?
- a) “What is your preferred brand?”
- b) “How many days per week or month are you using these analgesics?” (To assess for medication-overuse headache).
- c) “Do you find the packaging attractive?”
- d) “Are they on sale today?”
Answer: b) “How many days per week or month are you using these analgesics?” (To assess for medication-overuse headache).
28. If a child has a fever and is refusing to drink fluids or has significantly decreased urine output, this is a sign of:
- a) A mild fever that will resolve quickly.
- b) Potential dehydration, which is a reason for concern and possible medical referral.
- c) Normal behavior during a fever.
- d) The child not liking the taste of water.
Answer: b) Potential dehydration, which is a reason for concern and possible medical referral.
29. The “P” in PQRST for Provocation/Palliation refers to:
- a) The patient’s past medical history.
- b) What makes the pain worse (provokes) and what makes it better (palliates).
- c) The precise location of the pain.
- d) The pattern of the pain over time.
Answer: b) What makes the pain worse (provokes) and what makes it better (palliates).
30. A patient reports sudden onset of severe abdominal pain rated 9/10. The pharmacist should:
- a) Recommend a strong OTC pain reliever.
- b) Advise immediate medical evaluation due to the severity and sudden onset.
- c) Suggest they apply a heating pad.
- d) Ask them to wait 24 hours and see if it improves.
Answer: b) Advise immediate medical evaluation due to the severity and sudden onset.
31. The “S” in PQRST for Severity can be assessed using:
- a) A thermometer.
- b) A numeric rating scale (0-10), verbal descriptor scale, or FACES pain scale (for children).
- c) A blood pressure cuff.
- d) The patient’s own guess without any scale.
Answer: b) A numeric rating scale (0-10), verbal descriptor scale, or FACES pain scale (for children).
32. Which is an important component of the “Medications” assessment (part of SCHOLAR-MAC)?
- a) Asking only about prescription drugs.
- b) Asking about prescription drugs, OTC medications, herbal products, and dietary supplements.
- c) Asking only if the patient is taking any pain relievers.
- d) Asking only about medications taken in the last 24 hours.
Answer: b) Asking about prescription drugs, OTC medications, herbal products, and dietary supplements.
33. A patient with chronic liver disease requires an OTC analgesic for mild pain. Which agent is generally considered safer in appropriate doses, though caution is still warranted?
- a) Aspirin
- b) Ibuprofen
- c) Naproxen sodium
- d) Acetaminophen (with strict adherence to lower daily limits and avoidance of alcohol)
Answer: d) Acetaminophen (with strict adherence to lower daily limits and avoidance of alcohol) (NSAIDs carry higher risks of GI/renal issues which can be complicated in liver disease).
34. When assessing a patient’s pain that seems to be musculoskeletal, asking about _______ can help determine if it’s an acute injury or a chronic issue.
- a) their favorite food
- b) the mechanism of onset (e.g., sudden injury vs. gradual development) and duration of symptoms
- c) their preferred brand of shoes
- d) the color of their eyes
Answer: b) the mechanism of onset (e.g., sudden injury vs. gradual development) and duration of symptoms
35. A febrile seizure in a child, while often frightening, is typically considered a “red flag” requiring initial medical evaluation to:
- a) Ensure the child receives lifelong anti-seizure medication.
- b) Rule out more serious underlying causes of the seizure and fever (like meningitis) and provide parental education.
- c) Prove the child is allergic to fever.
- d) Stop all future immunizations.
Answer: b) Rule out more serious underlying causes of the seizure and fever (like meningitis) and provide parental education.
36. If a patient complains of a headache after a recent head injury, the pharmacist should:
- a) Recommend the strongest OTC pain reliever available.
- b) Advise immediate medical evaluation to rule out serious complications.
- c) Suggest they take a nap.
- d) Tell them it’s normal and will pass.
Answer: b) Advise immediate medical evaluation to rule out serious complications.
37. The “C” in SCHOLAR-MAC referring to “Coexisting Conditions” is important because:
- a) It helps the pharmacist understand the patient’s social life.
- b) Certain medical conditions may be contraindications or precautions for specific OTC pain/fever medications.
- c) All OTC medications are safe regardless of other conditions.
- d) It determines the price of the medication.
Answer: b) Certain medical conditions may be contraindications or precautions for specific OTC pain/fever medications.
38. Patient assessment for pain should include an evaluation of the pain’s impact on:
- a) Their favorite sports team.
- b) Their daily activities, sleep, and overall quality of life.
- c) The pharmacist’s schedule.
- d) The stock market.
Answer: b) Their daily activities, sleep, and overall quality of life.
39. A key difference to assess between a tension-type headache and a sinus headache is often the presence of:
- a) Nausea and vomiting (more common in migraine, but can differentiate some headaches).
- b) Bilateral pressure.
- c) Pain and pressure over the sinus areas, often with nasal symptoms (though migraine can mimic this).
- d) Aura.
Answer: c) Pain and pressure over the sinus areas, often with nasal symptoms (though migraine can mimic this).
40. If a patient presents with fever and a new, unexplained rash, the pharmacist should:
- a) Recommend a topical antifungal.
- b) Advise the patient to cover the rash and monitor it.
- c) Refer the patient for medical evaluation as this could indicate a serious infection or condition.
- d) Suggest an OTC antihistamine for the rash.
Answer: c) Refer the patient for medical evaluation as this could indicate a serious infection or condition.
41. The use of a pain diary can be helpful for patients with chronic or recurrent pain to:
- a) Track their pain levels, triggers, and effectiveness of treatments over time.
- b) Ensure they take more medication than prescribed.
- c) Share with friends on social media.
- d) Replace the need for medical consultation.
Answer: a) Track their pain levels, triggers, and effectiveness of treatments over time.
42. When assessing fever in an adult, it is important to ask about recent travel history, especially to areas with endemic infectious diseases, because:
- a) It helps plan their next vacation.
- b) Fever could be a symptom of a travel-related illness requiring specific medical attention.
- c) All fevers after travel are self-treatable.
- d) It determines which OTC antipyretic is best.
Answer: b) Fever could be a symptom of a travel-related illness requiring specific medical attention.
43. The term “referred pain” means:
- a) Pain that is not severe enough for medication.
- b) Pain that is felt in a location different from the actual site of injury or pathology.
- c) Pain that the patient has been referred to a specialist for.
- d) Pain that only occurs when referred to by others.
Answer: b) Pain that is felt in a location different from the actual site of injury or pathology.
44. If a patient taking an ACE inhibitor develops a persistent dry cough, this is an example of information gathered during which part of the SCHOLAR-MAC assessment?
- a) Symptoms
- b) History
- c) Medications (as a potential cause of the symptom)
- d) Location
Answer: c) Medications (as a potential cause of the symptom)
45. The primary goal of effectively assessing pain and fever is to ensure that the pharmacist:
- a) Can diagnose all underlying conditions.
- b) Makes an appropriate recommendation for self-care or referral, prioritizing patient safety.
- c) Sells the most products.
- d) Avoids talking to patients about these symptoms.
Answer: b) Makes an appropriate recommendation for self-care or referral, prioritizing patient safety.
46. A patient reports a “pins and needles” or “burning” type of pain in their feet. This quality of pain is often associated with:
- a) Acute muscle strain.
- b) Neuropathic pain.
- c) Tension headache.
- d) Osteoarthritis.
Answer: b) Neuropathic pain. (Generally an exclusion for self-care unless diagnosed and a specific OTC is part of plan).
47. When a patient reports taking multiple OTC products for their pain or fever, the pharmacist should assess for:
- a) Which product has the most attractive packaging.
- b) Potential therapeutic duplication (e.g., taking multiple products containing acetaminophen) or interactions.
- c) The lowest priced combination.
- d) Whether the patient can juggle all the bottles.
Answer: b) Potential therapeutic duplication (e.g., taking multiple products containing acetaminophen) or interactions.
48. A critical part of the “Talk with patient” step in the QuEST method, after assessing pain/fever and suggesting strategies, is to:
- a) Ensure the patient understands how to use the recommended product and when to seek further help.
- b) Give the patient a discount coupon.
- c) Ask the patient to write a positive review online.
- d) Take a photo with the patient.
Answer: a) Ensure the patient understands how to use the recommended product and when to seek further help.
49. A child with a fever who is also experiencing vomiting and/or diarrhea is at increased risk for:
- a) Faster recovery.
- b) Dehydration, requiring careful assessment of fluid intake and output.
- c) Developing a rash.
- d) Needing more sleep only.
Answer: b) Dehydration, requiring careful assessment of fluid intake and output.
50. If a patient describes their pain as improving with rest and worsening with movement, this information pertains to which parts of the PQRST assessment?
- a) Quality and Region
- b) Provocation/Palliation
- c) Severity only
- d) Timing only
Answer: b) Provocation/Palliation
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