Symptom Management and Approach to Care 2

1. Which may lead to seizures in hepatic failure?
2. Patient on long-acting morphine 15 mg P.O. TID, cachectic and now unable to swallow. Which would be the most convenient equianalgesic preparation?
3. Patient with ESRD on HD TIW with severe neuropathy wishes to avoid opiates and is not depressed. Choose most appropriate:
4. Patient on morphine PCA with basal (1 mg) per hour with bolus 1 mg every 10 minutes wishes to convert to Hydromorphone. Which is the closest equianalgesic dose of IV Hydromorphone (take into account incomplete cross-tolerance and round to the nearest correct answer)?
5. Methadone is safe and effective in a patient with hepatotoxicity.
6. DNR means “Do Not Treat.”
7. A health care proxy should have his/her own wishes as the paramount concern.
8. Causes of dyspnea are always irreversible.
9. Young children in the home increase the bereavement risk.
10. There is a slight preponderance of evidence for megestrol acetate versus dronabinol with regards to appetite stimulants. True or false?
11. Unresolved grief is a risk factor for complicated bereavement.
12. All patients placed on NSAIDs should receive PPI for GI prophylaxis.
13. There is a slight preponderance for benzodiazepine versus morphine in treatment of dyspnea.
14. Haloperidol is the most effective medication for treatment of singultus (hiccups).
15. Patient has a true morphine allergy, which is the safest choice for analgesia?
16. 38-year-old male with renal cancer is unable to swallow, has cachexia and tumor fevers, severe pain, and wants to die at home. On long-acting morphine 60 mg P.O. TID, what is the most appropriate next step?
17. Patient above is unable to clear secretions. Which is best choice?
18. All of the following medications may contribute to serotonin syndrome except:
19. 69-year-old African American male with a history of hypertension and type 2 DM with recent admit for CHF now resolved. GFR adjusted for ethnicity is 34 mL/min. Medications include digoxin, lisinopril, furosemide, candesartan, and metoprolol. Patient is preparing to discharge home. The new attending on service queries regarding hospice. The patient lived independently prior to admission and completed his ADLs independently while hospitalized. Your response is: