Hospice and Palliative Registered Nurse Certification exam 179 Questions with Verified Answers
Which assessment findings would most strongly suggest an
... [Show More] issue with morphine? - CORRECT ANSWER myoclonus is a symptom of the toxic effects of morphine metabolites
Which cancer is least likely to metastasize to the bone? - CORRECT ANSWER Colorectal; it mainly metastasizes to the liver, lung, and peritoneum.
What is the drug of choice to relieve a patient's feeling of "air hunger" in end stage pulmonary disease? - CORRECT ANSWER morphine; opioids provide palliative support for symptoms of breathlessness or suffocation.
What is not an appropriate intervention for a bowel obstruction - CORRECT ANSWER Metoclopramide
The classic signs of superior vena cava syndrome (SVCS) - CORRECT ANSWER facial edema, dyspnea, edematous arms w/bluish color=this is oncologic emergency requiring immediate attention.
anticipatory grief - CORRECT ANSWER the proces of psychological, social, and somatic reactions to a perceived future loss.
signs and symptoms of imminent death - CORRECT ANSWER dysphagia
stage II skin breakdown - CORRECT ANSWER skin is blistered, cracked or abraded
The state of having suffered a loss - CORRECT ANSWER bereavement
Disseminated Intravascular Coagulation (DIC) - CORRECT ANSWER focal ischemia, widespread thrombosis or bleeding, superficial gangrene, jaundice, acrocyanosis, altered sensation, ulceration of gastrointestinal system, decreased urinary output, and dyspnea.
prognosis of days to weeks, intervention for dysphagia - CORRECT ANSWER teach family the importance of oral hygiene to prevent complications such as mouth soreness and infections.
safety is a priority w/persons w/dementia - CORRECT ANSWER supervision, minimal stimulation, and discouraging sleep during daytime hours maximize night safety.
xerostomia - CORRECT ANSWER dry mouth, and can be a side effect of medications and a long term effect of radiation.
spiritual care of the hospice patient and family - CORRECT ANSWER identifies and strives to relieve the spiritual suffering of the patient and family
Grief - CORRECT ANSWER the feelings related to the perception of the loss and is a normal reaction to loss.
mentoring - CORRECT ANSWER a relationship between an experienced person and a less experienced person
Justice - CORRECT ANSWER to consider rules and actions that result in fair and equitable use of available resources.
medicare hospice benefit periods - CORRECT ANSWER 90-, 90-, and unlimited 60-day periods
crossing of professional boundaries - CORRECT ANSWER providing a personal cell phone number to the family
syncopal episodes and falls - CORRECT ANSWER consider discontinuing antihypertensive medications if blood pressure is consistently low
When revoking the medicare hospice benefit - CORRECT ANSWER The patient will lose the remaining days of the current period if they revoke the medicare hospice benefit
The dose-limiting side effect of morphine - CORRECT ANSWER Myoclonus=myoclonus is the chronic spasm of a muscle; if moclonus is present, accepted practice is to rotate to another opioid.
first priority when pt. unable to make own decisions and being cared for by family - CORRECT ANSWER knowing how the family makes decisions and who the decision makers are is priority.
therapy for stage II wounds - CORRECT ANSWER relieve pressure and apply protective/occlusive dressings.
starting oral dose for methadone - CORRECT ANSWER 2.5-5 mg every 8 hours (half dose for elderly or severe renal or liver disease)
side effect of methadone - CORRECT ANSWER prolong QT interval
equianalgesic conversion process -step one - CORRECT ANSWER step one- add up the total amount of the current drug given in 24 hours
remember to add in both the scheduled and breakthrough or rescue doses
Calculate separately if more than one drug
epuianalgesic conversion process -step two - CORRECT ANSWER step two- Divide current 24 hour total by the equianalgesic value for the current drug and route of administration.
Most commonly used opioid analgesics
Morphine-Parental 10mg/enteral 30mg
codeine-parental 130mg/enteral 200mg (not recommended)
fentanyl-parental 50-100 mcg/ enteral TRIF (transmucosal immediate release fentanyl)
hydrocodone- parental n/a enteral 30 mg.
hydromorphone- parental 1.5mg/enteral 7.5mg.
levorphanol-parental 2 mg acute, 1mg. chronic/enteral 4mg. acute 1 mg. chronic
methadone-parental unknown/ enteral unknown
oxycodone-parental n/a enteral 20mg.
equianalgesic conversion process- step three - CORRECT ANSWER Multiply the step 2 number by the equianalgesic value for the new drug and route (this will give you the new 24-hour dose
equianalgesic conversion process-step four - CORRECT ANSWER Determine how many doses the patient will take each day and divide this number into the total 24-hour dose (this gives the amount of medication needed per dose)
The usual cause of death for patients w/amyotrophic lateral sclerosis (ALS) - CORRECT ANSWER Respiratory failure from progressive muscle weakness.
Patients w/chronic renal failure - CORRECT ANSWER are not eligible for hospice until dialysis is discontinued
which of the following is the most appropriate patient to use a tricyclic antidepressant as an adjuvant analgesic? - CORRECT ANSWER a pt. w/diarrhea, the anticholinergic side effects of tricyclic antidepressants can cause constipation. diarrhea is not a major side effect of tricyclic antidepressants.
Barrier to patient communication - CORRECT ANSWER Anticipating what the patient will say, trying to determine what the patient will say limits the ability to listen to what they are saying.
Life review - CORRECT ANSWER Life review is about finding meaning and reflecting on memories of life events.
components of burn out - CORRECT ANSWER cynicism and depersonalization, emotional exhaustion, ineffectiveness and lack of personal accomplishment
Long-term cardiac toxicity of chemotherapy has symptoms similar to - CORRECT ANSWER Congestive heart failure -toxicity to the cardiac system induced by chemotherapy is similar in presentation to congestive heart failure w/dyspnea, cough, pedal edema, and poor response to diuretics or digitalis (most common w/anthracyclines)
glucose testing - CORRECT ANSWER can determine if the oftenvague symptoms of hypoglycemia are hypoglycemia so it can be treated, and thus lead to enhanced quality of life.
Pain associated w/patients w/multiple sclerosis - CORRECT ANSWER spasmodic pain-painful spasms are common in patients with multiple sclerosis as well as paroxysmal trigeminal neuralgia, optic neuritis, periorbital pain, extremity pain, including dysesthesia, allodynia, and painful electric shock sensations.
Brachytherapy - CORRECT ANSWER implanted radiation therapy, brachytherapy is a radioactive source that is placed inside of or directly on the body.
24 hour ceiling dose of acetaminophen for an 80 year old woman who does not have liver disease - CORRECT ANSWER 3000 gm, this is the max daily recommendation allowance of acetaminophen for an older adult.
Type of pain requiring antiepileptics and antidepressants for pain relief - CORRECT ANSWER neuropathic pain is generally due to damage to the nervous system. Adjuvants are often used to enhance the analgesic efficacy of opioids especially in cases of neuropathic pain. Antidepressants, anticonvulsants, and corticosteroids are examples of adjuvants useful in treating neuropathic pain.
Respiratory congestion during the dying phase - CORRECT ANSWER terminal secretions are caused by respiratory congestion during the dying phase, the less preferred term for noisy breathing is death rattle.
Schedule II drugs - CORRECT ANSWER should be disposed of by the hospice personnel (preferably the nurse who is responsible for medication management) and witnessed by a second individual as per the hospice's policy.
the obligation to "do good" - CORRECT ANSWER Beneficence
according to medicare hospice benefit regulations the 4 members of the core hospice services include - CORRECT ANSWER nurse, physicians, medical social services, and counselors (spiritual or bereavement)
hospice eligibility criteria for patients with late-stage human immunodeficiency virus (HIV) include - CORRECT ANSWER a CD4 count of <25/mm3 adn a karnofsky performance score of less than or equal to 50% along w/1 of 9 additional criteria (of which a central nervous system (CNS) lymphoma is 1)meet hospice eligibility criteria for HIV
treatment of seizures related to hypercalcemia - CORRECT ANSWER oral and/or intravenous fluids, this will decrease the effects of the high level of calcium
somatic pain - CORRECT ANSWER is aching, constant and well localized since it causes the activation of nociceptors in cutaneous and deep tissues.
nonsteroidal anti-inflammatory drugs - CORRECT ANSWER are NOT anti-spasmodics
major symptom of type A chronic obstructive pulmonary disease (COPD), which IS emphysema - CORRECT ANSWER dyspnea is the major symptom of type A copd, emphysema, it is also a symptom of type b copd, chronic bronchitis
calculating dose for breakthrough pain - CORRECT ANSWER guidelines recommend using 10% to 20% of the 24 hour oral dose, given every 1-2 hours as needed
end stage liver disease symptoms - CORRECT ANSWER encephalopathy, coagulopathy, malnutrition
the state of adaptation in which over exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time - CORRECT ANSWER definition is tolerance
dying patients adn their families - CORRECT ANSWER Patients and families search for meaning of the individual's life and seek a purpose during the dying phase
Hospice is - CORRECT ANSWER a philosophy of care to improve quality of life for the terminally ill persons and their families
in 2014 palliative care was primarily delivered - CORRECT ANSWER in acute care settings, either in a dedicated unit, outpatient clinic, or through palliative care teams
hospice care, private ins. vs. medicare - CORRECT ANSWER if a program is medicare certified, all patients must receive all the services available to a medicare beneficiary whether or not the insurance company pays
side effect of chemotherapy, can be asymptomatic but have serious life-threatening potential - CORRECT ANSWER neutropenia is silent but dangerous leaving no neutrophils to fight the threat of infections. Neutropenia can be the cause of a septic situation, which is life-threatening.
The focus of palliative care - CORRECT ANSWER The patient and family are the unit of care of both hospice and palliative care
It is inappropriate to suggest aggressive curative treatment - CORRECT ANSWER when the side effects of the treatment are more distressing than the potential benefits.
abstinence syndrome - CORRECT ANSWER occurs when a person who is physically dependent on an opioid abruptly stops taking the opioid.
lorazepam - CORRECT ANSWER can help w/insomnia and also is effective at reducing anxiety.
a patient is taking his breakthrough pain medication 6 times per day, the nurse should suggest - CORRECT ANSWER and increase in the amount of the scheduled dose. The baseline dose of long-acting opioids should be increased if more than 3 rescue doses are used in 24 hours.
lymphedema - CORRECT ANSWER can be treated w/lymphatic massage
hepatocellular cancer - CORRECT ANSWER has the best 5-year survival rate in the United States, overall survival rate for hepatocellular cancer is 17% in the U.S.
Barrier to pain management - CORRECT ANSWER fears regarding addiction, tolerance, and diverse effects related to analgesics, particularly opioids, still persist.
Allodynia - CORRECT ANSWER Pain from a stiumlus that does not usually cause pain
Reversible cause of anorexia/cachexia syndrome (ACS) in end stage illness - CORRECT ANSWER xerostomia, this is dry mouth and can be reversed or mitigated
A physical modality for pain relief that involves "life force energy" - CORRECT ANSWER Reiki, a japanese technique that is administered by "laying on hands" and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive
First step in the assessment of new onset diarrhea in a patient who uses dietary fiber - CORRECT ANSWER perform a digital rectal exam to rule out impaction; use and overuse of dietary fiber, especially with decreasing food and fluid intake, often causes impaction, which could manifest itself as new onset diarrhea (liquid stool is able to pass the impaction)
hypnosis - CORRECT ANSWER is a technique to enhance the mind's ability to affect the physical body. Hypnosis is a mind-body therapy.
Angina - CORRECT ANSWER typical angina includes constricting discomfort in the anterior chest (e.g. tight, heavy, squeezing), neck, shoulders, jaw, and/or arms; it can be precipitated by physical exertion; and is usually relieved by rest or nitroglycerine in 5 minutes.
Medicare Hospice benefit recertifications - CORRECT ANSWER Require a hospice physician or hospice nurse practitioner (NP) must have a face-to-face encounter w/each hospice patient prior to the beginning of the patient's third benefit period, and prior to each subsequent benefit period.
pain management for patients w/serious and persistent mental illness - CORRECT ANSWER studies have indicated that pain in undertreated in people w/a history of psychiatric disorders
Extrapyramidal symptoms (EPS) are a common symptom of - CORRECT ANSWER Parkinson's disease
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) - CORRECT ANSWER results in abnormal laboratory values of a urine osmolality that is higher than plasma osmolality and elevated urinary sodium.
Haloperidol - CORRECT ANSWER does NOT lower the seizure threshold
indication of an aggressively progressing lymphoma - CORRECT ANSWER T-cell origin; Lymphomas (Hodgkin's and non-hodgkin's) with a T-cell origin are known to be most aggressive in progression.
Most common symptom at end of life regardless of underlying disease - CORRECT ANSWER Fatigue is the most common symptom, followed by pain, terminal secretions/noisy breathing, delirium, dyspnea/cough, and urinary incontinence/retention.
Volunteer service hours - CORRECT ANSWER Volunteer service hours must account for 5% of all direct patient care hours for all paid hospice employees and contract staff in a medicare certified hospice program
Pleural effusion - CORRECT ANSWER exam will likely reveal decreased breath sounds on auscultation on the affected side , reduced transmission of the voice to the chest wall (vocal fremitus), and stony dullness on percussion
The first Palliative care program - CORRECT ANSWER Balfour Mount, a physician, founded the first palliative care program in 1975 in Montreal and was the first to use the the term "palliative" This was located at Royal Victorian Hospital, Montreal, Canada
Example of advocacy in hospice and Palliative care - CORRECT ANSWER advocacy is defined as promoting patient and family values, wishes, and preference of care, legal and ethical decision-making, and improved access to care and community resources by influencing or formulating health and social policy. An example of advocacy in hospice and palliative care would be negotiating continuous care reimbursement w/a private insurance company.
Hospice care became a medicare benefit - CORRECT ANSWER 1983, the tax equity fiscal responsibility Act created the Medicare Hospice Benefit and defined hospice care in the United States as legitimate medical care.
Most common non-cancer hospice admitting diagnosis, nationally - CORRECT ANSWER dementia; persons w/dementia comprise 15.2% of hospice diagnoses nationally with all non-cancer diagnoses at 63.5%
Scholarship assistance for certification - CORRECT ANSWER hospice and palliative Nurses Foundation (HPNF)
National Consensus Project for Quality Palliative Care - CORRECT ANSWER An organization that promotes quality palliative care, fosters consistent and high standards in palliative care, and encourages continuity of care across settings.
has its roots in the early hospice movement - CORRECT ANSWER care of the whole person; Early hospices, as early as the middle ages, promoted whole person care, including mind, body, soul, and spirit
Centers for medicare & medicaid - CORRECT ANSWER Do not regulate palliative care
The 3 common types of healthcare teams - CORRECT ANSWER multidisciplinary, interdisciplinary, and transdisciplinary
A multidisciplinary team - CORRECT ANSWER can be organized in a hierarchical manner
according to the medicare hospice benefit, the interdisciplinary group must review, revise, and document the individualized plan - CORRECT ANSWER at least every 15 days;
Peer review - CORRECT ANSWER a collegial, systematic , and periodic process by which clinicians are held accountable for practice and that fosters the refinement of one's knowledge, skills, and decision-making at all levels and in all areas of practice.
volunteers - CORRECT ANSWER are required by the centers for medicare & medicaid services to be part of the hospice interdisciplinary team
compassion fatigue - CORRECT ANSWER is almost identical to posttraumatic stress disorder (PTSD), except that it applies to those emotionally affected by the trauma of another ( usually a patient or family member)
3 of the 4 most common sites of metastatic disease in breast cancer - CORRECT ANSWER Bone, brain, and lung, symptoms include, bone pain, visual disturbances, shortness of breath
Neoadjuvant therapy - CORRECT ANSWER defined as treatment given prior to the primary treatment, e.g. chemo given to a patient w/colon cancer prior to surgical resection
most significant factor in prognostication in patients w/a cancer diagnosis - CORRECT ANSWER functional status; literature shows the patient's functional status is the most significant predictor in treatment tolerance and in overall survival
the most common presentation of spinal cord compression (SCC) - CORRECT ANSWER Back pain
symptoms of right-sided heart failure - CORRECT ANSWER as systemic congestion occurs in right-sided heart failure, symptoms include weight gain, dependent peripheral edema, ascites, weakness, anorexia and nausea.
Hospice eligibility guidelines for persons with neurodegenerative diseases include - CORRECT ANSWER rapid progression of symptoms, breathing difficulties, infections, diminished nutrition w/wt. loss and decreased albumin, sepsis, use of scales such as Karnofsky, palliative performance scale, and FAST are helpful.
The major medication group used to manage dyspnea in chronic lung conditions at the end of life - CORRECT ANSWER opioids and anxiolytics
terminal event of end stage liver disease - CORRECT ANSWER One possible terminal event in liver disease is bleeding from gastrointestinal or esophageal varices
Late-stage human immunodeficiency virus (HiV) is diagnosed when - CORRECT ANSWER CD4 count is less than 200 cells/mm3
hospice eligibility for human immunodeficiency virus (HIV) - CORRECT ANSWER viral load greater than 100,000 copies/ML
signs and symptoms of opioid abstinence (withdrawl) - CORRECT ANSWER anxiety, nausea, and lacrimation
visceral pain - CORRECT ANSWER pain that is poorly localized, cramping, and referred to distant sites.
nociceptive pain - CORRECT ANSWER pain generally well localized and described as aching or throbbing
Breakthrough pain - CORRECT ANSWER incidental, idiopathic, or can occur as end-of-dose failure
acetaminophen - CORRECT ANSWER is hepatotoxic in high doses and can compromise renal function
Nonsteroidal anti-inflammatory drugs - CORRECT ANSWER can increase the risk of myocardial infarction (MI) and stroke in people at risk for cardiovascular events.
opioid-induced respiratory depression - CORRECT ANSWER occurs more often in those with obstructive sleep apnea
subcutaneous morphine - CORRECT ANSWER has a delayed peak effect when compared with intravenous injections
antiepileptic drugs are effective for neuropathic pain - CORRECT ANSWER pregabalin has better bioavailability than gabapentin and can be given twice daily
Antidepressants are useful in relieving neuropathic pain - CORRECT ANSWER amitriptyline has significant anticholinergic effects and is not considered first line therapy as a result.
Corticosteroids, such as dexamethasone - CORRECT ANSWER Can relieve bone pain and right upper quadrant pain associated with liver metastases
Principles of opioid use include - CORRECT ANSWER reducing the dose by approximately 25% after performing an equianalgesic conversion accounts for incomplete cross-tolerance
Delirium - CORRECT ANSWER an acute change in level of arousal is the hallmark indicator of delirium
nonpharmacological intervention for myoclonus - CORRECT ANSWER Gentle massage may help with muscle relaxation and is an appropriate intervention
Healthy sleep practices - CORRECT ANSWER Listening to calming music, meditation, reading something soothing, or taking a hot bath are all examples of ways to help relax prior to bedtime
what is the most important piece of information when assessing dyspnea - CORRECT ANSWER patient's level of distress; dyspnea is a subjective symptom reported by the patient
Given in appropriate doses, morphine will slow respirations and relieve the feeling of air hunger - CORRECT ANSWER morphine's response is dose dependent and families should be reassured that starting with low doses and taking as prescribed would not hasten death.
stage II pressure ulcer - CORRECT ANSWER skin that is red and blistered; stage II pressure ulcers are partial loss of dermis as in the case of a blister
Irreversible cause of anorexia-cachexia - CORRECT ANSWER metastatic pancreatic cancer; metastatic pancreatic cancer is in its most advanced stage and is not curable or reversible. In addition, pancreatic cancer can have direct effects on digestion and advanced cancer can cause metabolic abnormalities leading to anorexia-cachexia
nonpharmacological treatment for nausea and vomiting - CORRECT ANSWER serve meals at room temperature
treatments required for opioid-induced constipation - CORRECT ANSWER stool softener and stimulant laxative daily;
cause of hiccoughs in a patient who has ascites - CORRECT ANSWER Phrenic and vagus nerve irritation; Ascites can cause hiccoughs by irritating the phrenic and vagus nerves
A patient treated for known psychosis exhibits uncontrollable muscle movements and spasms around the mouth, the pt. is experiencing - CORRECT ANSWER tardive dyskinesia; uncontrollable muscle movements and spasms around the mouth are classics signs of tardive dyskinesia, it is also associated w/antipsychotic medications
signs of posttraumatic stress disorder - CORRECT ANSWER Anxiety, intrusive memories, and distressing dreams
A delusion in which the individual is preoccupied with their state of health - CORRECT ANSWER Preoccupation with health is a sign of somatic delusions
Hoarding disorder - CORRECT ANSWER characterized by a persistent difficulty in parting with possessions to the point of excess often resulting in extreme clutter throughout the home
Patients with a psychiatric history - CORRECT ANSWER Often have undertreated pain
Excessive alcohol use is often underreported by patients - CORRECT ANSWER Insomnia, shaking, sweating, and agitation are common sign of alcohol withdrawal.
Nurses caring for patients with schizophrenia - CORRECT ANSWER should avoid physical contact when possible and warn patients when they must touch them
Complicated grief - CORRECT ANSWER yearning, intrusive thoughts and dreams, and guilt are all indicators of complicated grief more than 6 months post-loss
Puchalski's FICA - CORRECT ANSWER Faith (what faith does individual have), Influence (how influential is this faith), Community (what faith community does individual participate in), and Address (how would individual like the interdisciplinary team to address the individual's spiritual needs)
The search for ultimate meaning and purpose of life, which may involve a connection to a higher power - CORRECT ANSWER spirituality
In palliative care the "unit of care" consists of - CORRECT ANSWER Patient and family; patient and family make up the unit of care, providing care for the patient must include care for the family (as defined by the patient) as a singular unit
Comprehensive resource assessment - CORRECT ANSWER Includes collaboration with the interdisciplinary team
Cultural humility - CORRECT ANSWER a life-long process addressing power imbalances due to race, class, gender, sexuality, nation, ability, language, etc.
Culturally sensitive communication by the interdisciplinary team - CORRECT ANSWER is demonstrated by using professionally trained interpreters; try to avoid using family members as translators as they interpret through their own emotional and cognitive reactions.
good communication - CORRECT ANSWER fosters seamless continuity of care and improved patient outcomes.
Volunteer offender aides working in hospice prisons - CORRECT ANSWER report being able to atone for their own offenses; Volunteer offender aides have reported finding their own humanity and found value in being able to atone for their past offenses.
All veterans - CORRECT ANSWER have been impacted by the time they served in the military each in their own way.
Characteristic many rural dwellers share - CORRECT ANSWER they equate being healthy with being able to work; Health is viewed as the ability to work
Goals of advance care planning - CORRECT ANSWER determining values and priorities for end-of-life care; Values and priorities must be determined so that other planning/ decisions can be made.
Patients with an out-of-hospital do not resuscitate order - CORRECT ANSWER may revoke it at any time
The physician orders for life sustaining treatment (POLST) differs from a liveing will , POLST - CORRECT ANSWER Is a signed medical order by a provider; The Physician/provider/medical orders for life-sustaining treatment (POLST/MOLST) provides specific instructions/orders on several medical interventions and is signed by the provider
The self determination act (PSDA) was passed as a result of - CORRECT ANSWER The Nancy Cruzan case
The nurses' role in advance care planning - CORRECT ANSWER to complete his/her own advance directive; nurses who have already completed their own advance directives will be more comfortable discussing advanced directives w/patients
Barriers to completion of an advance directive include - CORRECT ANSWER fear of substandard care; Patients may feel care will not be provided
In the treatment of dyspnea, what is the rationale for directing a fan to the patient's face - CORRECT ANSWER stimulation of the baroreceptors; the baroreceptors, when stimulated, cause bronchial dilation, which is thought to reduce dyspnea
the guiding principle when providing care of the body after death - CORRECT ANSWER postmortem changes are temporary; All the postmortem changes, in particular rigor mortis, are temporary
Lethargy - CORRECT ANSWER is characteristic of hypoactive delirium
Restlessness can also occur as death nears - CORRECT ANSWER Benzodiazepines can have a paradoxical effect and worsen restlessness
An ethics of care focuses - CORRECT ANSWER on how and why nurses care for patients and not just caregiving actions; an ethics of care incorporates how and why nurses provide care to patients, integrating a professional moral life in to professional caregiving
The first step in resolving an ethical dilemma - CORRECT ANSWER identify the issue.
The patient's medical record - CORRECT ANSWER is not a professional resource
Patient's have the right to - CORRECT ANSWER refuse additional information about their condition and refer decision-making to a surrogate
Substituted judgment - CORRECT ANSWER a surrogate relies on known preferences of a patient to make a decision about medical care
Time- limited trial - CORRECT ANSWER establishes clear goals and boundaries of continuing life-prolonging therapy, thereby helping to frame the conversation for patients and families about withdrawal of care.
Rule of Double Effect (RDE) - CORRECT ANSWER The ethical justification for actions that have positive intended and negative unintended but foreseen effects.
the goal of palliative sedation - CORRECT ANSWER to relieve refractory symptoms in a terminally ill patient even when it means the patient may have reduced consciousness.
analgesic ceiling - CORRECT ANSWER the highest safe dose of a medication; acetaminophen has a recommended ceiling dose due to the potential to compromise hepatic and renal function. Pure opioids do not have a specific ceiling dose, though doses could be limited due to active metabolites. Note that opioid doses must be titrated up slowly.
High dose opioid therapy - CORRECT ANSWER has the potential to cause myoclonus due to increased levels of 3-glucuronide opioid metabolites, which are the most likely cause of the neuro-excitatory side effects.
routes and doses of octreotide - CORRECT ANSWER octreotide can be given subcutaneously(100-300 mcg 2-3 times/day), continuous intravenous or subcutaneous infusion (10-40 mcg/hr), or intramuscular depot injection (20mg intragluteally every 4 weeks once stabilized on intravenous/subcutaneous for at least 2 weeks). octreotide cannot be given orally.
challenges presented when using warfarin for patients who are debilitated - CORRECT ANSWER difficult to manage in patients wit poor oral intake; monitoring requires frequent venipunctures
teaching points for lidocaine patches - CORRECT ANSWER The patches should be placed over intact skin only, up to 3 patches can be used to cover the painful area; package insert instructs to apply for 12 hours and then remove for 12 hours, but it is safe to leave in place fro 18-24 hours; adverse effects are uncommon and include pain with removal of the patch; patients w/sensitivity to touch (also called allodynia) often report relief.
methylnaltrexone - CORRECT ANSWER inhibits opioid induced gastrointestinal slower motility
Baclofen - CORRECT ANSWER can cause sedation, insomnia, ataxia, and mental confusion
nausea related to gastric stasis - CORRECT ANSWER Prokinetic agents aid in stimulating motility of the upper gastrointestinal tract
metoclopramide - CORRECT ANSWER is a prokinetic agent (ie. stimulates motility of the upper gastrointestinal tract)
starting dose for metoclopramide - CORRECT ANSWER 10mg. every 8 hours
teaching for a patient using bupropion - CORRECT ANSWER cardiovascular side effects
The black box warning for celecoxib - CORRECT ANSWER includes cardiovascular events and gastrointestinal bleeds, though these are potential adverse effects for all NSAIDs
Partial agonist opioids - CORRECT ANSWER have the same precautions as pure opioids
side effect of opioids that is not time limited - CORRECT ANSWER Tolerance does not develop to opioid-induced constipation
calculating breakthrough dose: - CORRECT ANSWER oral: 10% to 20% of 24-hour dose available every 1 to 2 hours as needed;
Parenteral: 50% to 100% of the hourly rate every 15 minutes for most medication [Show Less]