CPHON Symptom Management and Supportive Care 1 — Questions and Answers
Question 1: A child undergoing chemotherapy reports mouth sores that prevent eating. The nurse documents this as:
- Xerostomia
- Stomatitis/mucositis (Correct answer)
- Esophagitis
- Oral candidiasis
Correct answer: Stomatitis/mucositis
Chemotherapy-induced mucositis (stomatitis) refers to inflammation and ulceration of the oral mucosa that can severely impair oral intake.
Question 2: Which intervention is MOST effective in preventing chemotherapy-induced nausea and vomiting (CINV) in children?
- Administering antiemetics after nausea begins
- Pre-medicating with antiemetics before chemotherapy (Correct answer)
- Restricting all oral intake during infusion
- Administering acetaminophen 30 minutes prior
Correct answer: Pre-medicating with antiemetics before chemotherapy
Antiemetics given before chemotherapy (prophylactically) are far more effective than treating nausea after it begins.
Question 3: A child on opioids for cancer pain develops constipation. The BEST intervention is:
- Increase dietary fiber alone
- Administer a stimulant laxative and stool softener (Correct answer)
- Discontinue opioids immediately
- Order a tap water enema
Correct answer: Administer a stimulant laxative and stool softener
Opioid-induced constipation requires a stimulant laxative (to promote motility) combined with a stool softener for safe, effective relief.
Question 4: A child with cancer who is in moderate pain rates it 7/10. According to the WHO analgesic ladder, the appropriate step is:
- Non-opioid only (acetaminophen/NSAIDs)
- Weak opioid (codeine/tramadol) + non-opioid
- Strong opioid (morphine) ± non-opioid (Correct answer)
- Topical analgesic alone
Correct answer: Strong opioid (morphine) ± non-opioid
Moderate-to-severe pain (6–10/10) corresponds to WHO Step 3, which calls for a strong opioid such as morphine, with or without adjuvants.
Question 5: To assess pain in a 3-year-old child with leukemia who cannot verbalize pain level, the nurse should use:
- Numeric rating scale (0–10)
- Visual analog scale
- FLACC behavioral pain scale (Correct answer)
- McGill Pain Questionnaire
Correct answer: FLACC behavioral pain scale
The FLACC scale (Face, Legs, Activity, Cry, Consolability) is validated for assessing pain in pre-verbal and young children via behavioral observation.
Question 6: A child receiving radiation therapy to the head develops hair loss. The nurse should explain that this hair loss is:
- Permanent in all cases
- Likely temporary if radiation dose is low, but may be permanent at high doses (Correct answer)
- Unrelated to the radiation field
- Only caused by concurrent chemotherapy
Correct answer: Likely temporary if radiation dose is low, but may be permanent at high doses
Radiation-induced alopecia is field-specific; at lower doses hair usually regrows, but high-dose cranial radiation can cause permanent hair loss.
CPHON Symptom Management and Supportive Care 1
A child undergoing chemotherapy reports mouth sores that prevent eating.
The nurse documents this as: