Management of Cancer Pain

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. The following statement/s about cancer is/are true

a) Cancer causes 1 of every 10 deaths worldwide
b) Pain associated with cancer in adults is frequently undertreated
c) Cancer is diagnosed in over 1 million Americans annually.
d) all are true

2. Causes of cancer pain include:

a) Tumor progression
b) Surgery or other invasive procedures
c) Toxicities of chemotherapy
d) all of the above

3. Approximately 90% of patients experiencing cancer pain can have their pain controlled through relatively simple means.

a) True
b) False

4. Controlling cancer pain is important because:

a) Unrelieved pain causes suffering.
b) Patients are less demanding if pain is well-managed.
c) Uncontrolled pain impairs the patient's participation in activities of daily living.
d) a & c

5. Cancer pain only occurs in the advanced stages of the disease.

a) True
b) False

6. There is not a correlation between pain and overall quality of life in cancer patients.

a) True
b) False

7. Which of the following is not an effect of cancer pain on the patient's quality of life?

a) Decreased functional capability
b) Depression
c) Increased appetite
d) Re-evaluation of religious beliefs

8. The following statement/s about pain are true:

a) Pain is a complex phenomenon involving physical, psychological, and emotional processes.
b) The amount of pain is proportional to the amount of tissue damage.
c) Pain can be managed with a standardized approach to therapy.
d) None of the above.

9. Barriers to effective cancer pain management include:

a) Healthcare professionals' fear of patient addiction.
b) The low priority given to cancer pain management within the healthcare setting as a whole.
c) a & b
d) neither a nor b

10. The following statement/s are true:

a) Reimbursement issues do not influence how pain is managed.
b) Low income people experience greater pain than do Americans of other socioeconomic classes.
c) Clinicians should not consider the cost of drugs when selecting pain management strategies.
d) all of the above

11. The initial evaluation of pain should include:

a) Detailed medical history
b) Physical examination
c) Psychosocial assessment
d) all of the above

12. The patient's self-report should be the primary source for the pain assessment.

a) True
b) False

13. A good pain assessment tool would be:

a) Brief
b) Easy to use
c) Comprehensive
d) all of the above

14. Pain should be assessed and documented

a) At regular intervals after starting the treatment plan.
b) When the patient reports a new type of pain.
c) 15-30 minutes after giving parenteral analgesics.
d) all of the above.

15. Discrepancies between the patient's observed behaviors and their self-report of pain are a result of:

a) Patient addiction or drug tolerance
b) Patient fear of what the pain means
c) Patient's use of diversionary activities
d) b & c

16. Common cancer pain syndromes include:

a) Bone metastasis
b) Spinal cord compression
c) Plexopathies
d) all of the above

17. Pain may precede overt neurological signs in spinal cord compression or spinal metastasis.

a) True
b) False

18. Possible causes of abdominal pain in cancer patients include/s:

a) Surgical conditions, e.g. appendicitis
b) Obstruction of the small or large intestine
c) metastatic liver disease
d) all of the above

19. Which of the following is not a potential cause of mucositis?

a) Cytotoxic chemotherapy
b) Radiation to the head and neck
c) Poor oral hygiene
d) Parenteral narcotics

20. Changes in pain patterns or the development of a new pain can routinely be attributed to preexisting causes.

a) True
b) False

21. It is essential to individualize analgesic regimens for the patient experiencing the pain.

a) True
b) False

22. Which is not an essential concept of the WHO approach to cancer pain management?

a) By the intravenous
b) By the clock
c) For the individual
d) By the ladder

23. It is most appropriate to treat persistent cancer related pain with "prn" doses only.

a) True
b) False

24. You are taking care of a leukemic patient who is experiencing generalized bone pain secondary to administration of growth stimulating factors. The patient is thrombocytopenic, with a platelet count of 35,000 mm3. The most appropriate drug to give for mild

a) ibuprofen
b) aspirin
c) acetaminophen
d) amantadine

25. You are working in an outpatient cancer clinic. You are taking care of a 78 year old woman with multiple myeloma. She has been taking ibuprofen for pain. She tells you that she is feeling some dull aching in her stomach and that her stool this morning was

a) telling her that the stomach discomfort is part of her cancer, and give her the ibuprofen
b) calling the MD for a laxative and enema order
c) comparing today's CBC results with those from last week, and notifying the MD other complaint
d) none of the above

26. Your 63 year old patient is receiving around the clock analgesics for metastatic bone pain. He has been taking oxycodone 10 mg. p.o. every 3 hours. He complains of unrelieved pain. You call the resident for additional orders. She orders to discontinue the

a) follow the order as given
b) question the pentazocine order because of the agonist-antagonist effect
c) question the order to dc the oxycodone rather thaN increasing the dose
d) b&c

27. Opioid tolerance and physical dependence are the same as drug addiction.

a) True
b) False

28. Your 35 year old patient has been receiving MS 10 mg. subcutaneously every 3 hours for post-op pain. She had a resection of a large abdominal tumor 5 days ago and continues to have significant pain in both the incision and her abdomen. She is now calling

a) call the doctor and get an order for Meperidine 100 mg IM or IV every 4 hours.
b) tell her to "tough-it out" and not take so much addictive pain medication.
c) recognize that analgesia dosages require adjustment as patients develop tolerance to the drug, and call the MD for new orders
d) none of the above

29. Physical dependence on opioids is defined by:

a) psychological addiction to the drug.
b) onset of criminal behavior to obtain drugs
c) appearance of abstinence syndrome after stopping the drug
d) need to increase dose requirements over time to achieve pain control

30. The oral route is the preferred route of analgesic administration.

a) True
b) False

31. A major limitation of transdermal opioid administration is that

a) it is not suitable for rapid dose titration
b) the administration method is complicated
c) some patients report nausea from the drug
d) all of the above are limitations

32. Your patient is receiving morphine by continuous IV infusion, with additional PCA dosing as needed. Your topics for patient teaching should include:

a) instructing the patient to use caution when ambulating if the medication makes them drowsy or confused
b) instructing the patient to increase dietary fiber, fluids, and to use a mild laxative as needed to prevent constipation
c) instructing the patient to use the PCA dose as little as possible to prevent addiction
d) a & b

33. Adjuvant drugs are used to enhance the analgesic efficacy ofopioids, treat concurrent symptoms that exacerbate pain, and provide additional analgesia for certain types of pain.

a) True
b) False

34. Which of the following adjuvant drugs may be useful in treatment of neuropathicpain?

a) dexamethasone
b) phenytoin
c) amitriptyline
d) b & c

35. Placebos should not be used in the management of cancer pain.

a) True
b) False

36. Discharge teaching for the cancer patient should include

a) a written pain management pain
b) information regarding activity or dietary restrictions
c) instructions for preventing constipation
d) all of the above

37. Although modalities which deliver deep heat (such as diathermy and ultrasound) should be used cautiously in patients with active cancer, superficial heat may be used as a method of pain control.

a) True
b) False

38. Cold packs should not be applied to tissue that has been damaged by radiation therapy.

a) True
b) False

39. Which of the following statements regarding exercise and cancer pain is/ are true?

a) Exercise assists in the treatment of chronic pain in many cases.
b) Patients should be encouraged to remain active as much as possible.
c) During acute pain, exercise should be limited to self-administered range of motion.
d) all of the above

40. Untoward effects of immobility include

a) joint contracture
b) cardiovascular deconditioning
c) both a & b
d) neither a nor b

41. Psychosocial interventions are not necessary until the cancer patient reaches the advanced stages of the disease, and therefore should not be introduced until that point.

a) True
b) False

42. Simple relaxation techniques such as focused-breathing exercises and progressive muscle relaxation are useful for patients

a) during episodes of brief pain
b) during unpleasant procedures
c) when the patient's ability to concentrate is compromised by anxiety
d) all of the above

43. Relaxation techniques are most helpful when combined with imagery.

a) True
b) False

44. The technique which teaches patients to monitor and evaluate negative thoughts and replace them with more positive ones is called.

a) distraction
b) counting
c) refraining
d) sublimation

45. Patient education for the cancer patient should include:

a) information about preventing pain through use of regularly scheduled analgesics
b) information to dispel myths about opioids
c) specific information about any medication the patient is given
d) all of the above

46. Spiritual and pastoral care can play an important role in a multidisciplinary approach to pain management

a) True
b) False

47. Invasive palliative approaches to cancer pain management should be used -after noninvasive methods are proven ineffective.

a) True
b) False

48. Indications for palliative radiation therapy include

a) symptomatic metastases due to tumor infiltration
b) initial debulking of large tumor masses
c) ablation of pain pathways
d) none of the above

49. The desired dosage of radiation should be administered in the fewest fractions possible to promote patient comfort.

a) True
b) False

50. Fibrosis is the most common type of late radiation injury.

a) True
b) False

51. Acute radiation effects occur primarily at skin and mucosal surfaces.

a) True
b) False

52. Anesthetic techniques, such as neurolytic blockades, should be used when other less invasive therapies are not effective or are inappropriate.

a) True
b) False

53. You are assigned to care for a patient who has had hypophysectomy for uncontrolled metastatic bone pain. You would expect to see post-op orders including.

a) anticoagulant therapy
b) hormone replacement therapy
c) antipsychotic therapy
d) none of the above

54. Which of the following is not aprinciple for surgical management of cancer pain?

a) the first resection offers the best opportunity for cure
b) outstanding radiotherapy can compensate for inadequate surgical resection
c) local tumor recurrence is not always the harbinger of disseminated disease
d) the timing of a surgical intervention for pain control is important.

55. Chronic pain syndromes may develop following specific surgeries, such as mastectomies.

a) True
b) False

56. Children with cancer consider painful procedures to be the most difficult part of having the disease.

a) True
b) False

57. You are preparing your patient for a painful procedure. Thepatient is 30 years old, alert, and experiencing bone pain. Your plan of care for the patient would include:

a) medicating the patient for the pre-existing pain prior to the procedure
b) explain what the procedure will entail and what to expect
c) incorporate nonpharmacological options such as music and imagery as appropriate
d) all of the above

58. Your patient receives morphine and midazolam prior to a bone marrow aspiration and biopsy. You would be most concerned about the potential for

a) nausea and vomiting
b) hypertension
c) respiratory depression
d) pain

59. You are setting up the procedure room to assist the physician with a bone marrow aspiration. The physician is going to use conscious sedation as a pain management strategy for the patient. You need to obtain which of the following items prior to the patie

a) patient-size-appropriate resuscitative equipment
b) pulse oximetry equipment
c) adequate amounts of nalozone for the patient's weight
d) all of the above

60. Children, elderly, and cognitively-impaired patients require thorough assessment and individualized pain management strategies when dealing with cancer pain.

a) True
b) False

61. Behavioral observation is the primary assessment approach for preverbal children.

a) True
b) False

62. The infant's metabolism is altered so that the blood-brain barrier is more permeable to opioids. Implications of this fact include:

a) young infants have higher in-brain concentration of opioids for a given dose than do children
b) intensive monitoring is needed for infants receiving opioids due to the increased risk of respiratory depression
c) both a & b
d) neither a nor b

63. You are caring for an 80 year old man with metastatic bone pain secondary to prostate cancer. The oncologist orders a pain regimen including NSAIDs and oral narcotics. As you administer the analgesics, you would

a) monitor for gastric and renal toxicity from the NSAIDs
b) be aware that elderly people tend to be more sensitive to the analgesic effects of opioids
c) monitor for urinary retention
d) all of the above.

64. Psychiatric symptoms in patients with cancer-related pain should be viewed initially as a possible consequence of uncontrolled pain.

a) True
b) False

65. Increased suicide risk is not correlated with uncontrolled pain.

a) True
b) False

66. The use of opioid agonist-antagonist compounds is contraindicated in suspected active opioid abuser.

a) True
b) False

67. PCA administration of narcotics contributes to further substance abuse in patients with a history of opioid abuse.

a) True
b) False

68. Patients with pain and substance abuse disorders require interdisciplinary assessment and care.

a) True
b) False

69. It is rare for an AIDS patient to experience pain.

a) True
b) False

70. The quality of pain management should be evaluated in all settings where patients with cancer receive care.

a) True
b) False

71. Cancer patients receive care in a multiplicity of settings. It is important to evaluate pain management at points of transition in the provision of services.

a) True
b) False

72. Which of the following principles should be incorporated in practice settings where cancer patients receive care?

a) patients should be informed that effective pain management is an important part of their treatment
b) patient satisfaction should d be surveyed to evaluate effectiveness of pain management
c) patients should be encouraged to use nonpharmacologic interventions rather than drugs
d) oral analgesics and other noninvasive routes of administration are used whenever possible.