Adult-Gerontology CNS Test Palliative Care & End-of-Life 1 — Questions and Answers
Question 1: What is the primary goal of palliative care for an adult-gerontology patient with a serious illness?
- Cure the underlying disease
- Relieve suffering and improve quality of life (Correct answer)
- Prolong life at all costs
- Transition the patient to hospice immediately
Correct answer: Relieve suffering and improve quality of life
Palliative care focuses on relieving suffering and improving quality of life for patients and families facing serious illness, regardless of prognosis or curative treatment status.
Question 2: A CNS is selecting a tool to assess overall symptom burden in an older adult receiving palliative care. Which instrument is most appropriate?
- Mini-Mental State Examination (MMSE)
- Edmonton Symptom Assessment System (ESAS) (Correct answer)
- Braden Scale
- Morse Fall Scale
Correct answer: Edmonton Symptom Assessment System (ESAS)
The Edmonton Symptom Assessment System (ESAS) is a validated, widely used tool specifically designed to assess multiple symptoms (pain, fatigue, nausea, depression, etc.) in palliative care populations.
Question 3: Which medication is the recommended first-line opioid for moderate-to-severe cancer pain in palliative care?
- Tramadol
- Codeine
- Morphine (Correct answer)
- Meperidine
Correct answer: Morphine
Morphine is the WHO-recommended first-line opioid for moderate-to-severe cancer pain and is the gold standard in palliative care analgesia.
Question 4: A patient with terminal cancer has a signed DNR order. Which ethical principle is most directly upheld by honoring this order?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Non-maleficence
Correct answer: Autonomy
Honoring a DNR order respects the patient's right to self-determination (autonomy), allowing them to refuse unwanted life-sustaining interventions.
Question 5: To be eligible for hospice care under Medicare, a patient's prognosis must be:
- Less than 3 months if the disease runs its natural course
- Less than 6 months if the disease runs its natural course (Correct answer)
- Less than 12 months if the disease runs its natural course
- Less than 1 month if the disease runs its natural course
Correct answer: Less than 6 months if the disease runs its natural course
Medicare hospice benefit requires certification by two physicians that the patient has a terminal prognosis of 6 months or less if the illness runs its expected course.
Question 6: A patient designates a family member to make healthcare decisions on their behalf if they become incapacitated. Which advance directive accomplishes this?
- Living will
- Physician Order for Life-Sustaining Treatment (POLST)
- Durable power of attorney for healthcare (Correct answer)
- Do-Not-Resuscitate order
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) legally designates another person to make medical decisions on the patient's behalf when they lack decision-making capacity.
Question 7: Cicely Saunders' concept of 'total pain' in palliative care encompasses which dimensions?
- Physical and psychological only
- Physical, psychological, social, and spiritual (Correct answer)
- Physical, cognitive, and functional
- Psychological, spiritual, and financial
Correct answer: Physical, psychological, social, and spiritual
Cicely Saunders defined 'total pain' as encompassing physical, psychological, social, and spiritual components, recognizing that suffering must be addressed holistically.
Adult-Gerontology CNS Test Palliative Care & End-of-Life 1
What is the primary goal of palliative care for an adult-gerontology patient with a serious illness?