21 Aug 2022 ( 145-156 )

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Palliative Care and End-of-Life Quiz

Test your knowledge on palliative care, pain management, and ethical decision-making related to end-of-life issues. This quiz covers essential topics that healthcare professionals need to understand when caring for terminally ill patients.

Key Topics:

Palliative Care Principles
Informed Consent
Patient Autonomy
Symptom Management
Ethical Considerations

13 Questions3 MinutesCreated by CaringDoctor123

145. The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. The nurse interprets that the patient has a general prognosis of which of the following?

A. 3 months or less to live

B. 6 months or less to live

C. 12 months or less to live

D. 18 months or less to live

146. Which one of the following statements about palliative sedation therapy (a patient is intentionally sedated to manage a refractory symptom) is false?

A. Palliative sedation done appropriately does not invariably shorten life

B. It is an ethically acceptable treatment modality so long as the intention is to control a refractory symptom

C. It invariably shortens life and therefore could be considered a form of euthanasia

D. It is generally required in only about 5 to 10% of patients at the end of life.

E. The most common reasons for initiating it are refractory delirium and dyspnea.

147. Abdullah is 66 and lives with his family. He has had heart problems for many years and he knows it is getting worse. He thinks he is probably dying, and would really like to be at home, with his loved ones, and die peacefully. The specialist has told his children that Abdullah has severe heart failure, it is incurable and he will die. They have asked that Abdullah not be told of his prognosis, because they worry the shock may kill him. They asked about a heart transplant, but the specialist says it is not appropriate. They have been in contact with a relative in the US, who says Abdullah should have an implantable defibrillator. The next time they see the specialist they will insist their father has this life saving procedure. But they don’t get the chance. Abdullah notices his ankles have started swelling and then one night he gets very breathless. The call and ambulance, it comes quickly, and Abdullah is admitted into hospital. His breathing is so bad they admit him into ICU. His usual specialist comes to see Abdullah, and explains to his family that he will not be able to come off the ventilator and medicines making his heart beat strongly. He is going to die in ICU. 1. When deciding to withhold or withdraw life-sustaining treatment form a patient with decision-making capacity, which of the following should receive the least consideration?

A. Medical indications for treatment

B. The wishes of the patient’s family

C. The patient’s wishes

D. The treatment’s potential benefits and burdens

148. Which of the following statements is a misconception about palliative care?

A. Palliative care interventions usually result in hastening death

B. A central goal of palliative interventions is to improve a patient’s quality of life.

C. No specific therapy is excluded from consideration as a palliative intervention.

D. Palliative medicine’s efforts do not effect hospital lengths of stay.

149. Which of the following statements is true?

A. Artificial nutrition and hydration (ANH) refers to syringe feeding with canned formula.

B. A substantial body of evidence suggests that ANH improves the quality of life of people dying from cancer and other terminal illness.

C. ANH can be withdrawn when it no longer meets its therapeutic goal.

D. Once ANH has been initiated, it requires ethics committee action for withdrawal.

150. If a physician opposed to a terminally ill patient’s treatment choice, such as instituting mechanical ventilation at the very end of life, the physician should do which of the following?

A. Help the patient find another physician who is comfortable implementing the patient’s choice.

B. Call a meeting of the ethics committee.

C. Attempt to convince the patient to make a decision the physician can support.

D. Refuse to provide futile care for the patient

151. A 52-year-old terminally ill man with unrelieved pain requests a prescription for a 3-month supply of secobarbital. You are concerned that his intention is to use the medication to end his life. In addition to calling for help from your team, what is the best response?

A. Refer the patient to a colleague who is likely to writ the requested prescription.

B. Listen to this concerns and document the conversation carefully.

C. Write a prescription for a 1-week supply of secobarbital and advise the patient to call for refills as needed.

D. Attempt to determine the cause of the pain and treat it aggressively

152. Which of the following statements about obtaining informed consent for research is true?

A. Because many terminally ill patients are often frail and confused and may suffer from multiple problems, it may be difficult for them to understand a request for informed consent; therefore, a proxy should always be consulted.

B. The roles of clinician and researcher should not be separated to avoid possible conflicts.

C. Obtaining informed consent should be an ongoing process that is revisited as the patient’s condition changes.

D. When a terminally ill patient’s cognitive ability is uncertain, there is rarely a need to use independent evaluators to formally determine cognitive ability

153. Ahmed is a 56-year-old patient with metastatic lung cancer and recurrent episodes of hypercalcemia. He initially responded to treatment with fluids and Pamidronate. When Ahmed is admitted to a hospice and palliative care service, his attending physician continues to care for him, and the program’s staff physician serves as a consultant. Ahmed decides he wants to discontinue treatment for his hypercalcemia, but the attending physician is unwilling to do so. Ahmed asked the hospice and palliative care physician for help. 7. At this point, which of the following is the best intervention?

A. Discontinue treatment without consulting Ahmed’s attending physician.

B. Tell Ahmed that he must follow the advice of this attending physician.

C. Call the attending physician and request a transfer of Ahmed’s case.

D. Initiate a thorough evaluation of Ahmed’s situation

154. At this point, which of the following is the best interventions?

A. Withdraw treatment without further discussion.

B. Continue treatment because the attending physician believes that it is essential.

C. Clarify treatment goals and consider ethical considerations.

D. Suggest that Ahmed’s care be transferred.

154. When using the FACES pain rating scale to assess a child’s pain, the correct procedure involves which of the following.

A. Ask the parent to match the child’s expression to one of the drawings

B. Ask the child to point to the face that best shows how much pain she has now

C. Hold the scale next to the child’s face and determine which drawing looks most like the child’s expression

D. Ask the child which face “on average” represents the way she feels

156. Which of the following is true?

A. No dosage adjustment is necessary when initiating long-acting benzodiazepines for patients with heath failure.

B. It is rare for patients with heart failure to become over sedated form opioids.

C. An appropriate starting dosage of an opioid for an opioid-naïve patient with hearth failure would be half of the usual starting dosage.

D. The dosing interval for long-acting benzodiazepines does not have to be adjusted to avoid excessive sedating for paients with heart failure.

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21 Aug 2022 ( 145-156 )

Palliative Care and End-of-Life Quiz

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