Activity 5: Symptom Management and Approach to Care 3 – Hospice & Palliative Board Review

Symptom Management and Approach to Care 3

1. Privacy notices may include a statement regarding the right of affected individuals to be notified following a data breach and must describe certain uses and disclosures of PHI that require patient authorization related to psychotherapy notes, marketing, and the sale of PHI.

A. True

B. False

2. Fundraising communications must provide recipients with a clear opportunity to opt out and the method provided for the opt out may not cause undue burden or more than nominal costs.

A. True

B. False

3. Hospice QAPI programs must meet every 14 days per CMS CoPs.

A. True

B. False

4. Hospice QAPI programs should have multi-disciplinary representation.

A. True

B. False

5. Respite services include a ten-day patient stay often at an SNF or ALF. True or false?

A. True

B. False

6. All of the following are hospice levels of care except:

A. General inpatient

B. Routine home care

C. Routine hospital care

D. Continuous care

E. Respite

7. All of the following are routinely covered by hospice care, except:

A. Symptom management medications

B. Oxygen

C. Physician services

D. Immunotherapy

E. Hospice nursing services

8. All of the following are true regarding hospice QAPI (quality assurance and performance improvement), except:

A. Should meet irregularly

B. Should include patient outcome measures (HIS, CAHPS)

C. Should include bereavement, volunteers, contracts

D. Should be multi-disciplinary

9. Which of the following is correct regarding hospice reimbursement?

A. Fee for service model

B. Patient/families pay a copay to the hospice provider

C. Occurs via a per diem

D. Not a reimbursable service

10. Which of the following is not an acceptable diagnosis for a certificate of terminal illness?

A. Parkinson’s disease

B. ALS

C. Alzheimer’s disease

D. Dementia

11. Opioid rotation should be considered when?

A. Lack of therapeutic response: patient develops tolerance to their current narcotic

B. Patient development of adverse effects on current opiates

C. Change in patient status (i.e. inability to swallow prior opiate regimen)

D. All the above are correct

12. Which of the following is correct regarding the WHO analgesic ladder?

A. Step 1 includes the use of moderate strength opiates

B. Step 1 includes the use of weak opiates

C. Step 1 includes the use of non-opioids and/or adjuvants

D. Step 1 includes the use of intrathecal interventions

13. Which of the following most accurately reflects high-dose opioid therapy?

A. >60mg of daily oral morphine equivalents

B. >90mg of daily oral morphine equivalents

C. >100mg of daily oral morphine equivalents

D. >120mg of daily oral morphine equivalents

14. One milligram of intravenous Hydromorphone is equivalent to how many milligrams of oral morphine?

A. 20

B. 10

C. 5

D. 30

15. Which of the following regarding methadone is not true?

A. Long half-life (30 +/- 16 hours)

B. Highly lipophilic

C. Fecal excretion-safe in ESRD

D. Safe in patients with hepatic cirrhosis

16. Which of the following regarding methadone is not true?

A. Methadone is a mu opioid agonist

B. Methadone is naturally occurring opioid

C. Methadone prevents MAO reuptake in periaqueductal gray

D. Methadone is an N-methyl-d-aspartate (NMDA) receptor antagonist

17. Which of the following regarding methadone is not true?

A. It is available as an oral tablet

B. It is available parenterally

C. It is not available as an oral liquid concentrate

D. It is not available as a transdermal preparation

18. Codeine is a pro-drug of which of the following?

A. Morphine

B. Diacetylmorphine

C. Hydromorphone

D. Oxymorphone

19. Which of the following is safe in the setting of a true morphine allergy?

A. Hydromorphone

B. Fentanyl

C. Oxycodone

D. Hydrocodone

20. 78-year-old male with history of CHF presents to ED with “funny feeling” in his chest. Patient found to have third-degree heart block in ED with digoxin level of 2.5 ug/mL. Patient is DNR/DNI. Most appropriate admission area would be:

A. Discharge to home with instructions to hold digoxin and follow up with PMD in 24 hours

B. Admit to the general medical floor

C. Admit to the observation unit

D. Admit to ICU