___________________________________________ Palliative Care and Pain Management at the End of Life
10. Which of the following is TRUE regarding advance directives? A) Most individuals have prepared advance directives. B) There are no cultural differences in the rates of advance directives. C) Advance directives have been associated with a lower likelihood of in-hospital death. D) The rate of advance directives is lower in the gay and lesbian community than the general population. 11. Evidence-based guidelines for palliative care interventions are available from the American College of Physicians for which of the following symptoms? A) Fatigue B) Depression C) Constipation D) Nausea and vomiting 12. Which of the following offers the best approach for the assessment of physical symptoms? A) Asking open-ended questions B) Traditional systems approach C) Asking which symptom is least troublesome D) Systematic assessment of symptoms plus open-ended questions 13. A patient’s fear to take opioids might be related to a belief that A) the side effects of opioids cannot be managed. B) the increase of pain signifies that the disease is getting worse. C) if he or she takes strong drugs now, no drugs will be effective in the future. D) All of the above
16. Which of the following is the most reliable indicator of pain? A) Patients’ self-report
B) Results of physical examination C) Results of functional assessment D) Results of multidimensional assessment
17. Referred pain is usually an indicator of A) bone pain.
B) visceral pain. C) tissue damage. D) central nervous system damage.
18. Strong evidence supports pain management approaches for people with which of the following life-limiting diseases? A) Cancer
B) HIV/AIDS C) Heart failure D) Cardiovascular disease
19. According to the World Health Organization (WHO) ladder, pain should be managed A) with only nonopioids for Steps 1 and 2. B) in every case, according to a stepwise progression from Step 1 to Step 3. C) in an individualized manner according to the intensity of the pain. D) with nonopioids given around the clock and opioids given on an as-needed basis. 20. Which of the following is TRUE regarding pain medications? A) Opioids have a ceiling effect. B) Meperidine is a recommended pain reliever in Step 3 palliative care. C) Methadone is an option for first-line treatment of severe pain. D) Intravenous administration of opioids is preferred over oral delivery. 21. Which of the following is considered the first-line opioid for Step 3?
14. Which of the following is FALSE regarding practitioner liability in pain management?
A) Undertreatment of pain carries a risk of malpractice liability. B) Breach of duty is difficult to prove in cases of inadequate pain management. C) Establishing malpractice requires evidence of breach of duty and proof of injury and damages. D) Careful documentation on the patient’s medical record regarding the rationale for opioid treatment is essential. 15. Which of the following is TRUE regarding end-of-life care for patients with a history of substance abuse? A) Opioids should be avoided for pain relief. B) The issues are the same for past and active substance abusers. C) Recurrence of addiction is high among recovered substance abusers. D) Long-acting pain medications are preferred for active substance abusers.
A) Fentanyl B) Morphine C) Methadone D) Oxycodone
22. Which of the following is TRUE regarding the management of fatigue?
A) Aerobic exercise has been shown to relieve fatigue. B) Additional rest/sleep is an effective strategy for alleviating fatigue. C) Fatigue should be aggressively treated in the last days or hours of life. D) Causal treatment should be provided rather than symptomatic treatment.
Self-Assessment questions continue on next page
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MDCA1525
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