AOCNP Palliative Care and Symptom Management 5

Question 1

A patient with advanced cancer develops hypercalcemia of malignancy (serum calcium 13.5 mg/dL). Which is the first-line pharmacologic treatment?

Accepted Answer

Intravenous bisphosphonate such as zoledronic acid after IV hydration

Answer

IV hydration followed by an IV bisphosphonate (zoledronic acid or pamidronate) is the first-line treatment for malignancy-associated hypercalcemia.

Question 2

When converting a patient from IV hydromorphone 1.5 mg/hour continuous infusion to oral extended-release opioids, the nurse practitioner should:

Accepted Answer

Calculate total 24-hour IV dose, apply equianalgesic conversion, and reduce by 25–30% for incomplete cross-tolerance

Answer

Equianalgesic conversion tables are used to calculate the equivalent oral dose, then a 25–30% reduction is applied to account for incomplete cross-tolerance during opioid rotation.

Question 3

A patient with advanced pancreatic cancer reports severe neuropathic pain described as burning and shooting despite adequate opioid dosing. Which adjuvant analgesic has the best evidence as a first-line addition?

Accepted Answer

Tricyclic antidepressant (nortriptyline) or gabapentinoid (gabapentin/pregabalin)

Answer

Tricyclic antidepressants and gabapentinoids are first-line adjuvant analgesics for neuropathic pain in cancer patients, per NCCN and WHO guidelines.

Question 4

Which ethical principle is most directly invoked when a palliative care NP provides high-dose opioids for refractory symptoms, accepting that respiratory depression is a possible but unintended side effect?

Accepted Answer

Doctrine of double effect

Answer

The doctrine of double effect justifies an action with both good (symptom relief) and potentially bad (respiratory depression) effects when the intent is the good effect and the good outweighs the harm.

Question 5

A patient receiving palliative radiation for painful bone metastases asks when to expect pain relief. The nurse practitioner should counsel that onset of analgesic effect typically occurs:

Accepted Answer

Within 1–4 weeks after the start of treatment

Answer

Palliative radiotherapy for bone pain typically produces a response within 1–4 weeks; partial or complete pain relief is achieved in approximately 60–70% of patients.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Palliative Care and Symptom Management 5