AOCNP Palliative Care and Symptom Management 2 — Questions and Answers
Question 1: Which scale is most widely validated for assessing pain intensity in cognitively intact cancer patients?
- Numeric Rating Scale (NRS 0–10) (Correct answer)
- FLACC scale
- CPOT scale
- Wong-Baker FACES scale
Correct answer: Numeric Rating Scale (NRS 0–10)
The 0–10 Numeric Rating Scale is the most widely validated and recommended self-report pain intensity tool for cognitively intact adults.
Question 2: Palliative sedation is ethically appropriate when:
- Refractory symptoms cannot be controlled by other means near end of life (Correct answer)
- The patient requests euthanasia
- Family members request it without patient consent
- Pain scores exceed 7 at any point in treatment
Correct answer: Refractory symptoms cannot be controlled by other means near end of life
Palliative sedation is ethically justified only for refractory, intractable symptoms at the end of life when all other interventions have failed.
Question 3: The Edmonton Symptom Assessment System (ESAS) measures which of the following?
- Nine common symptoms including pain, fatigue, and anxiety on a 0–10 scale (Correct answer)
- Functional status using a 0–100% scale
- Opioid equianalgesic conversions
- Prognosis using lab values and symptoms
Correct answer: Nine common symptoms including pain, fatigue, and anxiety on a 0–10 scale
The ESAS assesses nine symptoms (pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, wellbeing, dyspnea) each on a 0–10 scale.
Question 4: Which medication is first-line for neuropathic pain in cancer patients?
- Gabapentin or pregabalin (Correct answer)
- Ibuprofen
- Codeine
- Methadone as monotherapy
Correct answer: Gabapentin or pregabalin
Gabapentinoids (gabapentin or pregabalin) are first-line adjuvant analgesics for neuropathic pain in cancer patients.
Question 5: Opioid rotation is indicated when a patient experiences:
- Inadequate analgesia or intolerable side effects despite dose optimization (Correct answer)
- Any mild side effect within 24 hours
- Only when switching from oral to IV route
- Solely when insurance requires a generic
Correct answer: Inadequate analgesia or intolerable side effects despite dose optimization
Opioid rotation is indicated for inadequate pain control or unmanageable adverse effects, exploiting incomplete cross-tolerance to achieve a better balance.
Question 6: Which statement correctly describes the principle of double effect in palliative care?
- An action with both a beneficial and harmful effect is permissible if the intent is the beneficial effect (Correct answer)
- Any drug that may shorten life is unethical
- Symptom control must be withheld if it may cause respiratory depression
- Only nurses can invoke double effect principles
Correct answer: An action with both a beneficial and harmful effect is permissible if the intent is the beneficial effect
The principle of double effect allows administration of analgesics or sedatives where the intent is symptom relief even if a foreseeable, unintended consequence is hastening death.
AOCNP Palliative Care and Symptom Management 2
Which scale is most widely validated for assessing pain intensity in cognitively intact cancer patients?