CPHON Pain Assessment and Management in Pediatric Oncology 2

Question 1

A parent of a child with terminal cancer asks why morphine is being increased so frequently, saying: 'I'm afraid giving more pain medicine will make him die faster.' The nurse's most appropriate response addresses which ethical principle?

Accepted Answer

The principle of double effect: the intent is to relieve suffering, not hasten death, and adequate pain control is both an ethical obligation and does not shorten life when used appropriately

Answer

The principle of double effect addresses the ethical concern that a medication given to relieve suffering may have a foreseeable side effect of potentially hastening death. Evidence shows appropriate opioid titration for pain does not shorten life.

Question 2

A 15-year-old with osteosarcoma and bone metastases asks the nurse why she needs to take her oral morphine around the clock rather than just when in pain. The most accurate response is:

Accepted Answer

Cancer pain is often constant; scheduled dosing maintains a steady analgesic blood level to prevent pain from breaking through, while PRN dosing allows painful drug troughs

Answer

Chronic cancer pain is best managed with scheduled (around-the-clock) dosing to maintain consistent analgesic blood levels and prevent the pain-analgesic cycle of severe pain before dose and side effects after each PRN dose.

Question 3

A child's morphine dose has been titrated up to 0.2 mg/kg/dose every 4 hours and she now has stable pain but is experiencing constipation. The nurse should anticipate which intervention?

Accepted Answer

Initiate a scheduled stimulant laxative (senna or bisacodyl) as opioid-induced constipation does not resolve with tolerance and requires active management

Answer

Opioid-induced constipation (OIC) is caused by opioid binding to mu receptors in the GI tract, slowing motility. Unlike sedation, OIC does not develop tolerance and requires proactive, ongoing stimulant laxative therapy.

Question 4

Which adjuvant medication is most appropriate to add for a child with cancer pain from nerve compression causing neuropathic symptoms (burning, shooting pain)?

Accepted Answer

Gabapentin (Neurontin)

Answer

Gabapentin (a gabapentinoid/anticonvulsant) blocks voltage-gated calcium channels in dorsal horn neurons, reducing neuropathic pain transmission. It is the first-line adjuvant for pediatric neuropathic cancer pain.

Question 5

When converting a child from IV morphine to oral morphine, the nurse should apply which pharmacokinetic principle?

Accepted Answer

Oral morphine is approximately 3 times less potent than IV morphine due to first-pass hepatic metabolism, so the oral dose is 3 times higher than the IV dose

Answer

Oral morphine undergoes significant first-pass metabolism in the liver, reducing its bioavailability to approximately 30–40% of the IV dose. The equianalgesic ratio is IV:PO = 1:3 — thus the oral dose is approximately 3 times the IV dose to achieve equivalent analgesia.

CPHON Exam Practice Test

CPHON Exam Practice Test

CPHON Pain Assessment and Management in Pediatric Oncology 2