AOCNP Palliative Care and Symptom Management 1 — Questions and Answers
Question 1: Which opioid is considered first-line for moderate-to-severe cancer pain according to the WHO analgesic ladder?
- Morphine (Correct answer)
- Tramadol
- Codeine
- Acetaminophen
Correct answer: Morphine
Morphine remains the WHO-recommended first-line strong opioid for moderate-to-severe cancer pain at Step 3 of the analgesic ladder.
Question 2: A patient on long-acting opioids reports breakthrough pain. The appropriate breakthrough dose is approximately:
- 10–15% of the total daily opioid dose (Correct answer)
- 50% of the total daily opioid dose
- 100% of the single long-acting dose
- A fixed 5 mg morphine dose regardless of baseline
Correct answer: 10–15% of the total daily opioid dose
Breakthrough doses are typically 10–15% of the total 24-hour opioid dose to provide proportionate rapid-onset analgesia.
Question 3: Which non-pharmacological intervention has the strongest evidence for reducing cancer-related fatigue?
- Aerobic exercise (Correct answer)
- Vitamin C supplementation
- Prolonged bed rest
- Methylphenidate alone
Correct answer: Aerobic exercise
Aerobic exercise is the most evidence-based intervention for cancer-related fatigue, improving both physical and psychological components.
Question 4: Which antiemetic is most appropriate for opioid-induced nausea acting via the chemoreceptor trigger zone?
- Prochlorperazine (Correct answer)
- Ondansetron
- Dexamethasone
- Metoclopramide
Correct answer: Prochlorperazine
Prochlorperazine (a dopamine antagonist) acts on the chemoreceptor trigger zone (CTZ), which is the primary mechanism of opioid-induced nausea.
Question 5: A patient with cancer-related dyspnea refractory to oxygen is best treated with:
- Low-dose opioids (Correct answer)
- High-dose benzodiazepines alone
- Nebulized furosemide
- Inhaled beta-agonists
Correct answer: Low-dose opioids
Low-dose opioids are the most evidence-based pharmacological treatment for refractory dyspnea in cancer patients.
Question 6: Which laxative regimen should ALWAYS accompany opioid therapy to prevent constipation?
- A stimulant laxative such as senna (Correct answer)
- High-fiber diet alone
- Osmotic laxatives only as needed
- Bulk-forming agents such as psyllium
Correct answer: A stimulant laxative such as senna
A stimulant laxative (senna or bisacodyl) should be initiated prophylactically with opioids because tolerance to constipation, unlike other opioid side effects, does not develop.
AOCNP Palliative Care and Symptom Management 1
Which opioid is considered first-line for moderate-to-severe cancer pain according to the WHO analgesic ladder?