MCQ review
Palliative Care Pain Management Quiz
Test your knowledge on pain management in palliative care with this comprehensive quiz. Designed for healthcare professionals, it covers essential aspects of opioid rotation, adjuvant medications, and patient care strategies.
Challenge yourself with questions that focus on:
- Opioid dosing ratios
- Palliative care principles
- Adjuvant therapy options
- Patient communication in end-of-life care
1. When rotating from methadone to other opioids, the ratio is will be:
1 to 3
1 to 5
1 to 10
1 to 20
Which one of the following is not a key element of palliative care?
Pain & symptom management
Psychological & spiritual support
Getting the patient to be DNR
Coordination of care
Metastatic spinal cord compression can be the result of:
Vertebral collapse
Hypercalcaemia of malignancy
Chemotherapy treatment
Muscular spasm
A 28-year-old woman with advanced cystic fibrosis is hospitalized for a cystic fibrosis exacerbation. She has chronic chest-wall pain from coughing and pleurisy, and she recently broke 2 ribs for sighing. She is on IV glucocorticoids, IV ketorolac, IV ketamine prior to vest treatment, and lorazepam. Prior to her hospitalization, she took oxycodone ER 30mg q12h. Currently, she is on hydromorphone PCA at 2mg/hour with 2mg q30 minute boluses. Despite this, she is becoming drowsy and reports her pain is minimally improved and still severe for most of the day (7-8/10) and nearly intolerable” during vest therapy. Which of the following is the best step in management?
Increase her PCA basal and “bolus” doses by 50% monitor for 24 hours
Add a 5% lidocaine patch to her chest wall over her rib fractures
Discontinue hydromorphone; switch patient to another opioid
Advise primary team to stop vest therapies
Joan is 55-year-old female with hepatocellular carcinoma at home with hospice. She is currently o morphine extended release 60mg every 12 hours with morphine elixir 20mg every 3 hours as needed for pain. She describe her pain as mostly right upper quadrant pain that is constant and increases when she takes a deep breath. It is dull in nature, but with occasional sharp shooting episodes during the day. She is able to ambulate with assistance at them, eat a small amount, and interact with her family. The nurse call you and reports that Joan is complaining of more right upper quadrant pain that is not relived with breakthrough medication. She has doubled her breakthrough morphine with little pain relief and resultant somnolence. She asks if there is anything else we can offer for pain?
- What adjuvant pain medications would you consider for Joan?
Acetaminophen, 650 mg every 4 hours as needed for pain.
Dexamethasone, 4 mg PO twice a day.
Pamidronate, 90 mg IV
Gabapentin, 300 mg PO three times a day.
B and D correct
Joan starts taking schedules dexamethasone with good results. She has more energy, her appetite increases, and her pain improves for a week. The nurse call you to report that Joan is sleeping more, eating less, becoming more jaundiced, and is now essentially bedbound. She is grimacing and moving around uncomfortably in bed. The nurse is concerned about the patient not being able to take her extended- release morphine.
What would you recommend to the hospice nurse?
Start an SC morphine PCA at 2mg/hour with 1mg every 10 minutes as needed.
Crush the morphine extended release and give it to the patient in applesauce or pudding.
Start a fentanyl patch, 50 mg/hour and continue morphine concentrate for breakthrough.
Stop morphine ER and only give morphine concentrate as needed.
A and C correct
Joan is started on an SC PCA, and her pain is well-controlled. She is resting comfortably and occasionally wakes up and says a few words or takes a sip of water, then goes back to sleep. Joan’s family is worried that she is over sedated. The express concern that the morphine is hastening her death and feel uncomfortable with the “morphine drip”.
what should you do in this case?
Order naloxone and instruct the nurse to push at the bedside.
Listen to the family’s concerns and explore their underlying fears with the pain medication.
Talk to the family about what to expect at the end of life, and explain that for a patient on a stable dose of opioid the risk of oversedation is minimal and that the team is not hastening her death.
Rotate her opioid to dilaudid, because their main concern is with morphine.
B and C correct
A 68-year-old female with metastatic pancreatic cancer presents for management of severe diffuse abdominal pain. The patient recently quit chemotherapy to focus primarily on system management. Her pain has been poorly controlled with high dose oral opioids. Which palliative treatment is the best option?
Intrathecal opioid administration
Ethanol neurolysis of retroperitoneal plexus at L1
Palliative sedation
Spinal cord stimulation
Hospice care
Which of the following is a good option for non-destructive treatment of intractable cancer pain?
Intrathecal phenol
Intrathecal clonidine
Cordotomy
Rhizotomy
Myelotomy
A man taking opioids complains of “chronic itching all over” his body. Which of the following should be tried initially to relieve his pruritus?
Loratidine
Paroxetine
Diphenhydramine
Thorazine
Topical emollients
A man is taking oxycodone sustained-release 200mg twice daily and oxycodone immediate release 10mg at 2 tables 4 x daily. The patient develops dysarthria and can no longer take oral medications. He is switched entirely to a fentanyl patch. Which patch dose should be given?
25 mcg/hr patch
50 mcg/hr patch
100 mcg/hr patch
Two 100mcg/hr patches
A 51-year-old man with pancreatic cancer has diffuse, gnawing upper abdominal pain with a severity of 7/10. He is prescribed transdermal fentanyl 50ug/h, hydromorphone 4mg 2-3x daily for breakthrough pain, and ibuprofen 400mg twice daily. Four weeks later, the patient’s pain is well controlled on the current analgesics, but the opioids sometimes make him fell “foggy and sleepy.” Which of the following options should be considered for pain control with fewer side effects?
Increase ibuprofen to 800mg twice daily
Increase dose of transdermal fentanyl to 100ug/h every 48 hours
Change breakthrough medication to transmucosal fentanyl 800ug every 6 hours
Add nalbuphine 100 mg every 6 hours
Refer for consideration for celiac plexus block
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