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WorksheetsPain and Symptom Management
Total questions: 9
Worksheet time: 9mins
Mr. PE is a 65-year-old male with Stage IV lung cancer with metastases to the spine. He presents with increasing pain in his right shoulder and elbow and is experiencing severe debilitation related to metastatic disease. Spinal metastases have resulted in altered bowel patterns, and he has an indwelling Foley catheter.
Current Scheduled Medications
Sennosides 8.6 mg PO OD
Acetaminophen 650 mg PO QID
Dexamethasone 3 mg PO OD
Gabapentin 100 mg PO TID
Pantoprazole 40 mg PO OD
Hydromorphone Contin 15 mg PO BID
PEG 34 g PO OD
Fentanyl 25 mcg SL q15 min (Max 75 mcg/hr)
PRN Medications
Hydromorphone 3 mg PO Q1h PRN
Midazolam 2.5–5 mg SC q30 min PRN
Please list three different types of physical pain that patients like Mr. PE may experience due to their advanced cancer diagnosis? (Select the Best response).
a) Acute pain, chronic pain, referred neuropathic pain
b) Somatic pain, visceral pain, neuropathic pain
c) Emotional pain, spiritual pain, Visceral pain
d) Inflammatory pain, nociceptive pain, traumatic pain
2) Which two assessment tools can a nurse use to assess pain in palliative care patients? (Select the Correct response).
a) Braden Scale and Palliative Performance Scale (PPS)
b) Richmond Agitation Sedation Scale-Palliative Version (RASS- PAL) Scale & SQiD (Single Question in Delirium)
c) Edmonton Symptom Assessment System-Revised (ESAS-r) & Palliative Performance Scale (PPS)
d) Numeric Rating Scale (NRS) & Visual Analogue Scale (VAS)
3) Which palliative assessment tool is used to assess the top 10 most common symptoms experienced by palliative patients? (Select the Correct response).
a) Palliative Performance Scale (PPS)
b) Edmonton Symptom Assessment System-revised (ESAS-r)
c) Karnofsky Performance Scale
d) Brief Pain Inventory
4) Mr. PE is prescribed both dexamethasone and pantoprazole. What is the primary rationale for prescribing pantoprazole alongside dexamethasone in palliative patients? (Select the Correct response).
a) To enhance the analgesic effect of dexamethasone
b) To prevent opioid-induced constipation
c) To reduce the risk of gastric irritation and peptic ulcer formation
d) To improve appetite and nutritional intake
5) Mr. PE has an order for fentanyl 25 mcg SL q15 min (max 75 mcg/hr). This type of order is most commonly used to manage which type of pain in palliative patients? (Select the Best response).
a) Neuropathic pain
b) Incident (breakthrough) pain
c) End of dose failure (breakthrough) pain
d) Spontaneous (breakthrough) pain
6) Why are PRN opioid orders prescribed in addition to regularly scheduled long-acting opioids for patients with advanced cancer? (Select the Correct response).
a) To prevent opioid tolerance
b) To reduce the total daily opioid dose
c) To treat opioid withdrawal symptoms
d) To manage breakthrough or unpredictable pain episodes
7) As a nurse, can you initiate a consult with the Palliative Care Clinical Nurse Specialist (CNS) to assist with symptom management in patients with advanced chronic disease? (Select the Correct response).
a) No, only physicians can initiate a palliative consult
b) Yes, nurses or physicians can initiate a consult
c) Only social workers can initiate a consult
d) Only once the patient is registered with the palliative program
8) Which statement best describes the difference between a consultative palliative service and registration with the WRHA Palliative Care Program? (Select the Correct response).
a) Both require a prognosis of less than six months
b) Consultative services are only available after curative treatment ends
c) Registration allows symptom management, while consultative services do not
d) Consultative services can be accessed at any stage, while registration requires meeting specific criteria including prognosis, goals of care, and treatment limitations
