Question 1

Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?

Accepted Answer

Antipsychotics are the first-line therapy for delirium as they effectively manage the symptoms such as agitation, hallucinations, and delusions. Benzodiazepines can worsen delirium, while anticonvulsants and antidepressants have limited efficacy in managing delirium symptoms.

Question 2

Which characteristic of delirium helps to distinguish it from dementia?

Accepted Answer

Delirium has an abrupt onset, while dementia has a gradual onset.

Question 3

A patient had a transdermal fentanyl patch placed 2 hours ago and is not getting any pain relief.What would be the most appropriate intervention?

Accepted Answer

Prescribing a short-acting opioid for breakthrough pain would be the most appropriate intervention in this situation. It is important to address the patient's immediate pain needs while waiting for the fentanyl patch to take effect. Removing the current patch and replacing it with a higher dose or switching to a different intravenous opioid may be considered if the patient does not achieve adequate pain relief with the current regimen, but these are not the best initial interventions in this situation. Telling the patient to wait 12 hours for relief is not accurate and may cause undue discomfort and anxiety.

Question 4

According to the World Health Organization's analgesic ladder, which drug combination would be most appropriate in an opiate-na•ve patient who presents with moderate pain?

Accepted Answer

The World Health Organization's analgesic ladder recommends starting with non-opioid analgesics, such as NSAIDs (ibuprofen, naproxen, aspirin) or acetaminophen, for mild to moderate pain. If pain persists or becomes more severe, opioids such as morphine or fentanyl can be added. However, in an opioid-naïve patient, it is recommended to start with a weaker opioid such as hydrocodone, which can be combined with an NSAID or acetaminophen. Therefore, option D (Indomethacin/hydrocodone) is the most appropriate drug combination for a patient with moderate pain who has not been previously exposed to opioids.

Question 5

A patient with bone metastases from prostate cancer inquires whether he is a candidate for radiopharmaceuticals.Which of the following conditions would exclude him as a candidate?

Accepted Answer

Pathologic fracture indicates a high risk of fracture and would exclude the patient as a candidate for radiopharmaceuticals. A Karnofsky performance status of 65, life expectancy of 5 months, and hypocalcemia may affect treatment planning but would not necessarily exclude the patient as a candidate.

Question 6

A 75-year-old man is being treated as an outpatient for metastatic prostate cancer.Which of the following statements is true regarding the management of pain with opioids in the elderly?

Accepted Answer

Elderly patients often have decreased renal function, which can lead to accumulation of drugs and their metabolites, increasing the risk of toxicity. Opioids with a long half-life, like methadone, can accumulate and cause prolonged sedation or respiratory depression in the elderly. Serum creatinine alone is not a reliable measure of renal function in the elderly due to decreased muscle mass; creatinine clearance or estimated glomerular filtration rate (eGFR) provides a better assessment. Renal clearance of medications is generally slower, not faster, in the elderly, necessitating careful dosing and monitoring to avoid toxicity.

Question 7

Which of the following would be a cause of visceral pain?

Accepted Answer

Visceral pain is pain that originates from the organs within the body cavities, such as the abdomen. Intra-abdominal metastases are cancer cells that have spread to the abdominal organs and can cause pain. Bone metastases (A) would cause somatic pain, musculoskeletal inflammation (C) would cause somatic pain, and postsurgical incisional pain (D) would also be considered somatic pain.

Question 8

Some anticonvulsant drugs can be used as an adjuvant treatment for mild pain.

Accepted Answer

Some anticonvulsant drugs, such as gabapentin and pregabalin, have been found to be effective in treating neuropathic pain and are sometimes used as an adjuvant treatment for mild pain.

Question 9

Glycopyrrolate (Robinul) is one drug of choice to manage which of the following conditions that can contribute to dyspnea?

Accepted Answer

Glycopyrrolate (Robinul) is an anticholinergic medication that can be used to reduce secretions in the respiratory tract. Copious secretions can contribute to dyspnea by obstructing airways and making it difficult to breathe. Glycopyrrolate can help to alleviate these symptoms and improve breathing in patients with excessive secretions. While cough, anxiety and effusion can also contribute to dyspnea, glycopyrrolate would not be the drug of choice for managing these conditions.

Question 10

Which of the following statements is true regarding pain?

Accepted Answer

Pain is subjective and can be experienced in the absence of physical signs. It is also often related to actual or potential tissue damage. Chronic pain is typically more severe and debilitating than acute pain. However, option A is not true as it is unfair to assume that a patient is displaying drug-seeking behaviors simply because they complain of pain but don't exhibit physical signs.

Question 11

Which of the following is a role of the advanced practice nurse in palliative cancer care?

Accepted Answer

The advanced practice nurse in palliative cancer care plays multiple roles including detecting cancer in asymptomatic patients or those with specific symptoms, arranging for follow-up care including psychosocial and spiritual support, and identifying and managing complications of care. Therefore, option D is the correct answer.

Question 12

If a patient requires six rescue doses for breakthrough pain in a 24-hour period, what would be an appropriate intervention?

Accepted Answer

If a patient requires six rescue doses in a 24-hour period, it suggests that their baseline long-acting medication dose is not adequately controlling their pain. Therefore, the appropriate intervention would be to increase the dose of the long-acting medication to provide better pain control throughout the day. Simply increasing the dose of the rescue short-acting medication may lead to increased side effects and is not a long-term solution. Switching to a different rescue medication may be an option, but addressing the underlying issue with the long-acting medication should be the first step. Doing nothing would not be appropriate if the patient is experiencing breakthrough pain.

Question 13

Oxygen has shown no benefit in alleviating dyspnea in patients without hypoxemia.

Accepted Answer

Studies have shown that oxygen therapy does not provide significant relief from dyspnea in patients without hypoxemia, and may even be harmful in some cases. Therefore, it is not recommended for routine use in these patients. However, oxygen may still be needed in certain situations such as during exercise or in end-of-life care.

Question 14

What would be an appropriate dose of morphine to give an opioid-na•ve patient to manage tachypnea associated with dyspnea?

Accepted Answer

The answer of What would be an appropriate dose of...

Question 15

Patients who are receiving life-prolonging therapies do not qualify for palliative care.

Accepted Answer

Palliative care can be provided alongside life-prolonging therapies, in order to improve quality of life and manage symptoms. It is not just for end-of-life care.

Question 16

A patient is receiving long-acting oxycodone for pain control.The clinician thinks that he also will benefit from a short-acting oxycodone for breakthrough pain.How will the clinician figure out what the dose of short-acting oxycodone should be?

Accepted Answer

The most commonly used guideline for calculating the dose of short-acting opioids for breakthrough pain is to prescribe 10% to 20% of the total 24-hour dose of the long-acting opioid. This can be administered every 2-4 hours as needed for pain control. Therefore, choice A is the correct answer.

Question 17

A patient is preparing to be discharged to home with hospice.She is on a morphine patient-controlled analgesia (PCA) in the hospital.She is concerned as to whether she can stay on her morphine PCA at home even when she is not able to give herself boluses.What would be an appropriate response from the clinician?

Accepted Answer

It is possible for a trained family member or nurse to activate the dosing button on the PCA pump when the patient is unable to do so. This option allows the patient to continue using the PCA for pain management at home. It is important for the patient and their family to receive thorough education and training on the proper use of the PCA pump before leaving the hospital.

Question 18

Which of the following is the best description of dyspnea?

Accepted Answer

Dyspnea is a subjective feeling of breathlessness, making option D the best description. Option A refers to a measure of oxygen saturation, option B refers to respiratory rate, and option C describes a psychological state, but none of these fully captures the symptom of dyspnea.

Question 19

A patient is being switched from hydromorphone to methadone in an attempt to achieve better pain control.How much should the dose of methadone be reduced when calculating the equianalgesic dose of the two drugs?

Accepted Answer

When switching a patient from hydromorphone to methadone, the dose of methadone should be significantly reduced due to its high potency and the risk of accumulation. A reduction of 90% is often recommended to account for methadone's long half-life and strong opioid effect.

Question 20

A patient taking PO hydromorphone for pain control has developed dysphagia.The clinician decides to switch the patient to IV hydromorphone.What ratio of IV:PO hydromorphone does the clinician need to know to calculate the proper dose?

Accepted Answer

The oral bioavailability of hydromorphone is lower than its intravenous form. The IV:PO conversion ratio for hydromorphone is typically 1:5, meaning the IV dose is about 1/5 of the oral dose to achieve the same effect.

Quiz 20: Palliative Care