COCN Cancer Pain and Symptom Management — Questions and Answers
Question 1: According to the WHO analgesic ladder, what is the first step for managing mild cancer pain?
- Non-opioid analgesics such as acetaminophen or NSAIDs (Correct answer)
- Strong opioids like morphine
- Nerve blocks
- Radiation therapy for pain control
Correct answer: Non-opioid analgesics such as acetaminophen or NSAIDs
The WHO analgesic ladder starts with non-opioid medications (acetaminophen, NSAIDs) for mild pain (Step 1), progressing to weak opioids (Step 2) and strong opioids (Step 3) as pain intensity increases.
Question 2: What is breakthrough pain in cancer patients?
- Transient flares of pain that occur despite around-the-clock analgesic therapy (Correct answer)
- Pain that breaks through the skin surface
- Pain caused by physical therapy exercises
- The initial pain felt at cancer diagnosis
Correct answer: Transient flares of pain that occur despite around-the-clock analgesic therapy
Breakthrough pain is a temporary flare of moderate to severe pain that occurs despite adequate background pain control with around-the-clock medications, requiring fast-acting rescue medications.
Question 3: What nursing assessment tool is appropriate for evaluating pain in non-verbal cancer patients?
- FLACC scale or behavioral pain assessment tools (Correct answer)
- Numeric rating scale (0-10)
- Visual analog scale
- Brief Pain Inventory
Correct answer: FLACC scale or behavioral pain assessment tools
Non-verbal patients require behavioral observation tools like the FLACC scale (Face, Legs, Activity, Cry, Consolability) that assess pain through observable indicators rather than self-report.
Question 4: What is cancer-related fatigue (CRF) and how does it differ from normal tiredness?
- A persistent, distressing sense of exhaustion not proportional to activity and not relieved by rest (Correct answer)
- Normal tiredness after exercise
- Temporary fatigue during chemotherapy only
- Drowsiness from pain medications
Correct answer: A persistent, distressing sense of exhaustion not proportional to activity and not relieved by rest
CRF is a distressing, persistent sense of physical, emotional, and cognitive exhaustion related to cancer or its treatment that is disproportionate to recent activity and not fully relieved by rest or sleep.
Question 5: What is mucositis and which cancer treatment most commonly causes it?
- Inflammation and ulceration of mucous membranes, most common with high-dose chemotherapy and head/neck radiation (Correct answer)
- A skin rash from targeted therapy
- Muscle inflammation from immunotherapy
- Bone marrow suppression from surgery
Correct answer: Inflammation and ulceration of mucous membranes, most common with high-dose chemotherapy and head/neck radiation
Mucositis is painful inflammation and ulceration of the mucosal lining of the GI tract (especially the mouth), most commonly caused by high-dose chemotherapy, head and neck radiation, and stem cell transplant conditioning regimens.
Question 6: What is the nurse's role in managing chemotherapy-induced nausea and vomiting (CINV)?
- Administering antiemetics per protocol, assessing effectiveness, and implementing non-pharmacologic interventions (Correct answer)
- Prescribing antiemetic medications independently
- Only providing emotional support
- Withholding all fluids during treatment
Correct answer: Administering antiemetics per protocol, assessing effectiveness, and implementing non-pharmacologic interventions
Nurses play a critical role in CINV management by administering prescribed antiemetics (preventively and as needed), assessing their effectiveness, adjusting timing, and implementing complementary strategies like dietary modifications and relaxation techniques.
