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ER called to see your patient who is 60 years old with metastatic lung cancer. He presented to ER with deep sedation, delirium with visual hallucinations. When examined him, you noticed involuntary muscular jerks in many muscle groups. He takes Oxycodone SR 100 mg PO Q12h and Oxycodone IR 10mg PO Q1h PRN. According to his wife that he’s been taking a lot of BTs due to pain with an average of 8 times per day. You diagnosed him with Opioid toxicity and decided to admit him and rotate him to SC hydromorphone. What is his new dose of hydromorphone?

Hydromorphone 70mg SC Q4h and 42 SC Q1h PRN.

Hydromorphone 14mg SC Q4h and 8mg SC Q1h PRN.

Hydromorphone 10.5mg SC Q4h and 6mg SC Q1h PRN.

Hydromorphone 7mg SC Q4h and 4mg SC Q1h PRN.

Hydromorphone 3.5mg SC Q4h and 2mg SC Q1h PRN

Which of the following interventions is least likely to relieve the suffering associated with serious or life-threatening illness?

Providing a calm and empathetic presence

Ordering diagnostic tests to locate the primary site of a cancer

Communicating effectively

Setting short-term, attainable goals

Which of the following statements about pain is true?

Physical pain is never the most important contributor to suffering.

Total pain refers to the physical, psychological, spiritual, and social pain experienced by dying patients.

The distress associated with spiritual pain rarely exacerbates physical symptoms.

Well-controlled physical symptoms interfere with a patient’s ability to interact with loved ones.

Which of the following actions is most likely to help physicians cope with the stresses associated with caring for dying patients?

Never acknowledge periodic feelings of grief, helplessness, and fear.

Let go of attachments to family and outside interests and concentrate on professional activities.

Exercise, rest, and practice a spiritual discipline.

Refuse to let others meddle in the management of difficult cases.

Which of the following reactions to a spouse’s death is least expected?

Periods of breathlessness or fatigue

Brief visual and auditory hallucinations of the deceased

Periodic thoughts of not wanting to go on living

Calm acceptance of the death within a week

Which of the following is least likely to predict a person’s reaction to a traumatic loss?

The nature of the person’s attachment to the deceased

Personality factors such as a tendency to depression

Previous responses to expected and timely losses

Presence of supportive networks such as family, church, or social groups

Which of the following statements about grief is least likely to be true?Reactions to a death are affected by the bereaved person’s attachment to the deceased.

Ambivalent relationships are unrelated to complicated grief.

Prolonged yearning and anger are common reactions to the death of a child.

Protracted disorganization is a common reaction to the death of a spouse.

Which of the following is least likely to characterize a successful adaptation to loss?

Rebuilding assumptions about the world and self

Making sense of the loss by reconstructing meaning

Concentrating on work-related activities and ignoring the loss

Letting go of previous roles that can no longer be maintained

Which of the following is the least important aspect of the developmental tasks of the dying?

Completing all unfinished business before death occurs

Developing an enlarged and renewed sense of personhood and meaning

Bringing as much closure as possible to personal and community relationships

Accepting increased dependency

Which of the following statements about meaning is true?

The need for meaning is only determined by culture.

Common sources of meaning include family, work, and religious or political affiliations.

Sources of meaning are unlikely to change over the course of a lifetime.

Most people can identify one unifying meaning for their lives.

Which of the following statements about suffering is true?

Suffering does not occur in the absence of physical pain.

Suffering is rarely related to thoughts about the future.

Suffering results from losses that threaten a person’s entire sense of self.

Suffering increases when the integrity of personhood is restored by reestablishing meaning and hope.

When physical pain contributes to suffering, which of the following interventions is most likely to be helpful?

Challenge the validity of the patient’s experience of pain.

Avoid upsetting the patient with information about the source of pain, even when requested.

Demonstrate that pain can be controlled with adequate dosages of appropriate medications.

Help patients reframe the meaning of comfort.