Activity 9: Management of Non-Pain Conditions 3 | Hospice & Palliative Board Review

Management of Non-Pain Conditions 3

1.

Which of the following hospice (respective diagnosis listed) patients is most likely closest to death?

A. Patient with stage 4 lung cancer, PPS 50

B. Patient with CVA and right-sided hemiparesis, PPS 30

C. Patient with Alzheimer’s disease, PPS 10

D. Patient with ACC/AHA stage D, CHF, PPS 30

2.

A hospice QAPI (quality assurance and performance improvement) program should track all of the following data except:

A. Patient falls

B. Patient CAUTIs (catheter-associated urinary tract infections)

C. Staff needlestick injuries

D. Referrals from skilled nursing facility physicians

3.

Methadone would be a reasonable choice for analgesia in all of the following except?

A. Patient with stage 4 prostate cancer with refractory pain

B. Patient with BMI of 40, baseline CO2 of 43, with ES COPD and refractory pain

C. Patient with stage 4 breast cancer with refractory pain

D. Patient with end-stage multiple myeloma, end-stage renal disease, and refractory pain

4.

All of the following patients are hospice appropriate except:

A. Patient with stage 4 prostate cancer, PPS 30

B. Patient with Alzheimer’s disease, FAST 7a, PPS 30

C. Patient with NYHA class 3 CHF, PPS 60

D. Patient with stage 4 breast cancer, PPS 30

5.

Which of the following is true regarding ketamine?

A. Should be initiated in opioid naive patients

B. Available orally only

C. Available intravenous only

D. May exert part of its analgesic efficacy through NMDA antagonism

6.

Which of the following is not true regarding NSAIDs?

A. May cause GI bleeding

B. May cause thrombocytopenia

C. Are completely safe in geriatric patients

D. Can be effective in inflammatory pain

7.

Which of the following is the most reasonable treatment for severe dyspnea in a patient with end-stage COPD, DNR/DNI, who desires comfort only and is opioid naïve?

A. ATC morphine 2 mg IV Q4H

B. ATC Hydromorphone 2 mg IV Q4H

C. ATC fentanyl 200 mcg IV Q4H

D. Morphine infusion 2 mg per hour

8.

84-year-old male with hospice diagnosis of end-stage COPD, PPS 30, with comorbid type 2 DM and diabetic peripheral neuropathy utilizing minimal oral opiates presents with constipation, nausea, and vomiting. Which is the most optimal antiemetic?

A. Methylnaltrexone

B. Ondansetron

C. Metoclopramide

D. Haloperidol

9.

49-year-old female with stage 4 breast cancer and insomnia, depression with decreased oral intake, and PPS 50. Which of the following is the best choice of therapy?

A. Fluoxetine

B. Sertraline

C. Venlafaxine

D. Mirtazapine

10.

Which of the following opioids is most likely to cause myoclonus?

A. Oxymorphone

B. Hydormorphone

C. Morphine

D. Methadone

11.

Buprenorphine is so potent because it is a pure opioid agonist.

A. True

B. False

12.

Buprenorphine is available transdermally and sublingually.

A. True

B. False

13.

Buprenorphine is available intravenously.

A. True

B. False

14.

In hospital palliative care, services always lead to increased hospice utilization in their communities.

A. True

B. False

15.

Supportive care encompasses both hospice and palliative services.

A. True

B. False

16.

Palliative care should be focused only on patient and family goals of care.

A. True

B. False

17.

Aprepitant (substance P inhibitor) has been shown to be an effective analgesic and antiemetic.

A. True

B. False

18.

Olanzapine can be effective as an antiemetic as well as an antipsychotic.

A. True

B. False

19.

Direct thrombin inhibitors are safe in end-stage renal disease, unlike low molecular weight heparinoids.

A. True

B. False

20.

The benefits for atypical antipsychotic use in Alzheimer’s patients with agitation clearly outweigh their risks.

A. True

B. False