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.
COCN Cancer Pain and Symptom Management
According to the WHO analgesic ladder, what is the first step for managing mild cancer pain?