Question 1

Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?&#10;A)Benzodiazepines&#10;B)Antipsychotics&#10;C)Anticonvulsants&#10;D)Antidepressants

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?&#10;A)Abrupt onset&#10;B)Impaired attention&#10;C)Affective changes&#10;D)Delusions

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?&#10;A)Remove the current patch and replace with a new fentanyl patch at a higher dose.&#10;B)Prescribe a short-acting opioid for breakthrough pain.&#10;C)Remove the patch and switch to a different intravenous opioid.&#10;D)Tell the patient not to worry, as it takes about 12 hours for the patch's effects to be felt, and he will have relief at that time.

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&#8226;ve patient who presents with moderate pain?&#10;A)Ibuprofen/imipramine&#10;B)Naproxen/morphine&#10;C)Aspirin/fentanyl&#10;D)Indomethacin/hydrocodone

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?&#10;A)Karnofsky performance status of 65&#10;B)Pathologic fracture&#10;C)Life expectancy of 5 months&#10;D)Hypocalcemia

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?&#10;A)Opioids with a long half-life, such as methadone, are a good choice, because they stay in the system longer, and patients do not have to remember to take multiple pills.&#10;B)Serum creatinine is the best measurement of renal function in the elderly and should be done prior to the initiation of treatment with opioids.&#10;C)Renal clearance of medications is faster in the elderly, so higher dosages of medications are needed to adequately control pain.&#10;D)None of the above

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?&#10;A)Bone metastases&#10;B)Intra-abdominal metastases&#10;C)Musculoskeletal inflammation&#10;D)Postsurgical incisional 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?&#10;A)Copious secretions&#10;B)Cough&#10;C)Anxiety&#10;D)Effusion

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?&#10;A)If a patient complains of pain but has no physical signs, he or she is most likely exhibiting drug-seeking behaviors.&#10;B)Acute pain is more intense and severe than chronic pain.&#10;C)Pain is a subjective experience related to actual or potential tissue damage.&#10;D)All of the above

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?&#10;A)Detecting cancer in asymptomatic patients or those with specific symptoms&#10;B)Arranging for follow-up care, including psychosocial and spiritual support&#10;C)Identifying and managing complications of care&#10;D)All of the above

Accepted Answer

The answer of Which of the following is a role...

Question 12

If a patient requires six rescue doses for breakthrough pain in a 24-hour period, what would be an appropriate intervention?&#10;A)Increase the dose of the baseline long-acting medication.&#10;B)Increase the dose of the rescue short-acting medication.&#10;C)Switch to a different short-acting rescue medication.&#10;D)Do nothing, because this is appropriate, and the patient's pain is well controlled.

Accepted Answer

The answer of If a patient requires six rescue doses...

Question 13

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

Accepted Answer

The answer of Oxygen has shown no benefit in alleviating...

Question 14

What would be an appropriate dose of morphine to give an opioid-na&#8226;ve patient to manage tachypnea associated with dyspnea?&#10;A)5 mg PO every 4 hours&#10;B)15 mg PO every 4 hours&#10;C)30 mg PO every 4 hours&#10;D)40 mg PO every 4 hours

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

The answer of Patients who are receiving life-prolonging therapies do...

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?

A)The short-acting dose should be 10% to 20% of the total 24-hour long-acting dose.
B)The short-acting dose should be 40% to 50% of the total 24-hour long-acting dose.
C)The short-acting dose should be 10% to 20% of each long-acting dose.
D)The short-acting dose should be 40% to 50% of each long-acting dose.

Accepted Answer

The answer of A patient is receiving long-acting oxycodone for...

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?

A)"We are unable to prescribe a PCA for use at home.If you are comfortable on the PCA, you should remain in the hospital."
B)"It would be possible for your nurse or another trained family member to activate the dosing button when you are unable to do so."
C)"A PCA is not an appropriate method of pain medication delivery once you are unable to use the dosing button.I will switch you to another form of pain control."
D)"You should not be concerned about your pain management at home.It will be taken care of for you."

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Accepted Answer

The answer of A patient is preparing to be discharged...

Question 18

Which of the following is the best description of dyspnea?&#10;A)An oxygen saturation of less than 90%&#10;B)Respiratory rate greater than 24&#10;C)A psychological state resulting in the feeling of air hunger&#10;D)A subjective feeling of breathlessness

Accepted Answer

The answer of Which of the following is the best...

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?

A)0%
B)20%
C)50%
D)90%

Accepted Answer

The answer of A patient is being switched from hydromorphone...

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?

A)1:1
B)1:2
C)1:5
D)1:7

Accepted Answer

The answer of A patient taking PO hydromorphone for pain...

Deck 20: Palliative Care