Adult-Gerontology CNS Test Palliative Care & End-of-Life 2 — Questions and Answers
Question 1: A patient is actively dying and develops noisy breathing due to pooling of secretions. Which medication is most appropriate?
- Furosemide IV
- Glycopyrrolate (Correct answer)
- Albuterol nebulizer
- Methylprednisolone
Correct answer: Glycopyrrolate
Glycopyrrolate, an anticholinergic agent, reduces salivary and bronchial secretions and is a first-line treatment for the terminal death rattle without crossing the blood-brain barrier.
Question 2: An actively dying patient has refractory dyspnea unrelieved by oxygen or bronchodilators. What is the most appropriate pharmacological intervention?
- Lorazepam IV infusion
- Low-dose oral morphine (Correct answer)
- High-flow oxygen mask
- Dexamethasone IV
Correct answer: Low-dose oral morphine
Low-dose opioids (morphine) are the most evidence-based pharmacological intervention for refractory dyspnea at end of life, reducing the subjective sensation of breathlessness.
Question 3: Which assessment scale is commonly used to evaluate a dying patient's level of consciousness and alertness at end of life?
- Glasgow Coma Scale (GCS)
- Palliative Performance Scale (PPS)
- Richmond Agitation-Sedation Scale (RASS) (Correct answer)
- Confusion Assessment Method (CAM)
Correct answer: Richmond Agitation-Sedation Scale (RASS)
The Richmond Agitation-Sedation Scale (RASS) is frequently used in palliative care to assess level of consciousness and guide sedation for terminal agitation and palliative sedation.
Question 4: What is palliative sedation (also called terminal sedation)?
- Administering opioids to hasten death
- Reducing consciousness to relieve refractory suffering at end of life (Correct answer)
- Providing sedation for procedural pain in terminally ill patients
- Using anxiolytics to treat anticipatory grief
Correct answer: Reducing consciousness to relieve refractory suffering at end of life
Palliative sedation involves intentionally reducing a patient's consciousness to relieve intractable suffering when other symptom management strategies have failed, not to hasten death.
Question 5: A CNS observes an actively dying patient whose respirations alternate between periods of apnea and rapid, deep breathing. This pattern is most consistent with:
- Kussmaul respirations
- Biot's respirations
- Cheyne-Stokes respirations (Correct answer)
- Apneustic breathing
Correct answer: Cheyne-Stokes respirations
Cheyne-Stokes respirations are characterized by a cyclical pattern of gradually increasing then decreasing depth of breathing alternating with apneic episodes, commonly seen in dying patients.
Question 6: What is the typical time frame of the 'active dying' phase (the final stage of dying)?
- Days to weeks
- Hours to days (usually 24–72 hours) (Correct answer)
- Weeks to months
- Several hours only
Correct answer: Hours to days (usually 24–72 hours)
The active dying phase typically lasts hours to days (most commonly 24–72 hours) and is characterized by mottling, decreased urine output, altered breathing, and unresponsiveness.
Question 7: Which medication class is considered first-line for treating terminal restlessness and agitation in dying patients?
- Beta-blockers
- Antipsychotics (haloperidol) (Correct answer)
- SSRIs
- Calcium channel blockers
Correct answer: Antipsychotics (haloperidol)
Haloperidol, a typical antipsychotic, is the first-line agent for terminal restlessness/agitation (terminal delirium) due to its efficacy in reducing agitation with minimal respiratory depression.
Adult-Gerontology CNS Test Palliative Care & End-of-Life 2
A patient is actively dying and develops noisy breathing due to pooling of secretions.
Which medication is most appropriate?