Activity 14: Approach to Care, Prognosis | Hospice & Palliative Board Review

Approach to Care, Prognosis

1.

A nurse practitioner may serve as a hospice medical director.

A. True

B. False

2.

A nurse practitioner may serve as an attending for a hospice patient.

A. True

B. False

3.

It is more difficult to prognosticate for non-oncologic diagnoses than it is for oncologic diagnoses.

A. True

B. False

4.

A Medicare-certified hospice must have at least 15% of its hours provided by volunteers.

A. True

B. False

5.

A CNA must be present during each team IDT meeting.

A. True

B. False

6.

The most recent average length of stay (ALOS) for any hospice patient in the United States is 90 days.

A. True

B. False

7.

Hospital inpatient palliative care services have been shown to increase hospice utilization in the communities they serve.

A. True

B. False

8.

While hospice and palliative care may differ, they face the same barriers to implementation.

A. True

B. False

9.

A patient in a skilled nursing facility may simultaneously be on hospice and skilled care.

A. True

B. False

10.

The initial hospice benefit is divided into 3 60-day benefit periods.

A. True

B. False

11.

Which of the following is (are) not acute side effects of radiation therapy?

A. Nausea and vomiting

B. Fibrosis

C. Edema

D. Mucositis

12.

Patient is 59-year-old female with stage 4 non-small cell lung cancer. Family desires to keep patient at home on hospice, pain is well controlled but now with significant EOL dysphagia. Prior regimen is LA morphine 100 mg P.O. Q12H and MSIR 30 mg P.O Q4H PRN (average 3 BTP dose/24hr). What is PCA morphine basal and bolus dose?

A. Morphine basal 1 mg/hr bolus 1 mg Q10MIN

B. Morphine basal 2 mg/hr bolus 1 mg Q10MIN

C. Morphine basal 3 mg/hr bolus 2 mg Q10MIN

D. Morphine basal 4 mg/hr bolus 2 mg Q10MIN

E. Morphine basal 8 mg/hr bolus 4 mg Q10MIN

13.

Which of the following patients (all with same stage disease) could likely most benefit from palliative care?

A. Newly diagnosed breast cancer ER+, PR+, Her2Neu-

B. Newly diagnosed breast cancer ER+, PR+, Her2Neu+

C. Newly diagnosed breast cancer ER+, PR-, Her2Neu-

D. Newly diagnosed breast cancer ER-, PR-, Her2Neu-

14.

Which of the following is not typically used in the treatment of neutropenic fever?

A. Cefepime

B. Ceftriaxone

C. Meropenem

D. Piperacillin/tazobactam

15.

An elderly patient has stage 4 lung cancer with decline in functional status and PPS of 20. The family would like to know “how long?” Your best estimate is:

A. Hours to days

B. Days to weeks

C. Weeks to months

D. Months to years

16.

Which of the following regarding PEG tubes in end-stage Alzheimer’s disease patients is correct?

A. PEG tubes improve quality of life

B. PEG tubes prevent aspiration pneumonia from occurring

C. PEG tubes improve quantity of life

D. PEG tubes increase risk for infection

17.

Which of the following is least likely to cause serotonin syndrome?

A. Atomoxetine

B. Fluoxetine

C. Duloxetine

D. Tramadol

18.

All of the following are CAGE questions except:

A. Have you ever felt you needed to cut down on your drinking?

B. Have people annoyed you by criticizing your drinking?

C. Have you ever felt guilty about drinking?

D. Have you ever been depressed about drinking?

E. Have you ever felt you needed a drink first thing in the morning (eye opener)?

19.

You are asked to see a patient in consultation for opioid withdrawal; you are told the patient has a COWS (Clinical Opiate Withdrawal Scale) score of 14. You determine:

A. The patient is not in opiate withdrawal

B. The patient is in mild opiate withdrawal

C. The patient is in moderate opiate withdrawal

D. The patient is in severe opiate withdrawal

20.

Which of the following is not a substance/drug abuse risk screening tool?

A. DAST

B. HAM-D

C. ORT

D. SOAPP

21.

Which of the following is not associated with poor prognosis in patients with Covid-19?

A. Multiple Medical Comorbidities

B. Elevated CRP

C. Lymphocytosis

D. Elevated LDH

E. Older age

22.

What is the median incubation period (in days) for Covid-19?

A. 2 days

B. 3 days

C. 5 days

D. 7 days

E. 14 days

23.

Which of the following symptom clusters would be most consistent with Covid-19 presentation?

A. Rhinitis, headache, diarrhea

B. Rhinitis, nausea, diarrhea

C. Headache, nausea, diarrhea

D. Fever, non-productive cough, dyspnea & myalgias

E. None of the above

24.

Which of the following confirmed Covid-19 positive patients would benefit most from early palliative consultation?

A. Previously healthy 39-year-old female with no chronic medical conditions

B. 52-year-old with mild COPD and no other chronic medical conditions

C. 49-year-old female with diastolic CHF and no other chronic medical conditions

D. 67-year-old with Alzheimer’s Dementia (FAST 6C) and no other chronic medical conditions

E. 82-year-old with Alzheimer’s Dementia (FAST 7E) and recently diagnosed myelodysplastic syndrome

25.

Which of the following statements from the Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) are false?

A. None, all of the below statements are true.

B. In adults with COVID-19, we suggest starting supplemental oxygen if the peripheral oxygen saturation (SPO2) is < 92% and recommend starting supplemental oxygen if SPO2 is < 90% (strong recommendation, moderate quality evidence).

C. For the acute resuscitation of adults with COVID-19 and shock, we suggest using a conservative over a liberal fluid strategy

D. For the acute resuscitation of adults with COVID-19 and shock, we recommend using crystalloids over colloids

E. In adults with COVID-19 and acute hypoxemic respiratory failure on oxygen, we recommend that SPO2 be maintained no higher than 96%