CPHON Pain Assessment and Management in Pediatric Oncology

Question 1

A 3-year-old with ALL is crying, holding her leg, and refusing to walk. The nurse should use which pain assessment tool?

Accepted Answer

FLACC scale (Face, Legs, Activity, Cry, Consolability)

Answer

Numeric Rating Scale (NRS) 0–10

Answer

McGill Pain Questionnaire

Answer

Brief Pain Inventory

Question 2

A child with cancer reports a pain score of 8/10 from bone metastases. Current pain management includes acetaminophen 15 mg/kg PO every 6 hours. Per the WHO analgesic ladder for pediatric pain, the next appropriate step is:

Accepted Answer

Addition of an opioid analgesic (e.g., oral morphine or oxycodone) as the pain has not responded to non-opioid therapy alone

Answer

Adding a second non-opioid NSAID

Answer

Increasing the acetaminophen dose beyond the maximum

Answer

Waiting to see if the pain resolves spontaneously

Question 3

A 10-year-old receiving IV morphine for cancer pain develops increased drowsiness, respiratory rate of 8 breaths/minute, and pinpoint pupils. The priority nursing intervention is:

Accepted Answer

Administer naloxone (Narcan) IV per protocol and prepare for airway support

Answer

Hold the next morphine dose and continue monitoring

Answer

Administer supplemental oxygen and elevate the head of the bed

Answer

Notify the provider and wait for orders before acting

Question 4

What is the primary advantage of using a patient-controlled analgesia (PCA) pump for pain management in pediatric oncology patients?

Accepted Answer

Allows the patient to self-administer small bolus doses on demand, improving pain control and sense of autonomy

Answer

Eliminates the need for any scheduled opioid doses

Answer

Removes nursing responsibility for pain assessment

Answer

Guarantees that the patient will not develop opioid tolerance

Question 5

A nurse notes that a child's cancer pain is described as burning, shooting, electric-shock-like, and worsens at night. This presentation is most consistent with which type of pain?

Accepted Answer

Neuropathic pain from tumor invasion or chemotherapy-induced peripheral neuropathy

Answer

Somatic pain from bone metastases

Answer

Visceral pain from organ involvement

Answer

Procedural pain from repeated lumbar punctures

Question 6

Which non-pharmacologic intervention is most evidence-based for reducing procedure-related pain and anxiety in pediatric oncology patients during bone marrow aspiration?

Accepted Answer

Virtual reality (VR) distraction combined with guided imagery or hypnosis techniques

Answer

Having parents leave the room to prevent reinforcing anxiety behaviors

Answer

Telling the child 'this won't hurt' before the procedure

Answer

Using restraint to ensure the child stays still