Palliative Care and Symptom Management Flashcards

A patient with advanced lung cancer reports severe dyspnea at rest despite supplemental oxygen. Which intervention has the strongest evidence for relieving refractory dyspnea in this setting?

Answer: Low-dose systemic opioids

Low-dose systemic opioids (e.g., oral morphine) are the most evidence-based pharmacologic intervention for refractory dyspnea in advanced cancer.

When titrating opioids for cancer pain, a patient on oral morphine 60 mg/day has inadequate relief. What is the appropriate dose increase per standard palliative care guidelines?

Answer: Increase by 25–33%

Standard practice recommends increasing the total daily opioid dose by 25–33% when pain is inadequately controlled.

A hospice patient develops myoclonic jerks and hyperalgesia after high-dose morphine. Which action best addresses opioid-induced neurotoxicity?

Answer: Opioid rotation to a different agent such as hydromorphone

Opioid rotation (switching to an equianalgesic dose of a different opioid) reduces neurotoxic metabolite accumulation and relieves opioid-induced neurotoxicity.

Which of the following best describes the concept of 'total pain' as used in palliative care?

Answer: The multidimensional suffering encompassing physical, psychological, social, and spiritual components

Dame Cicely Saunders defined 'total pain' as the interplay of physical, psychological, social, and spiritual dimensions of suffering.

A patient with malignant bowel obstruction is not a surgical candidate. Which combination is most appropriate for symptom management?

Answer: Opioids for pain, an antisecretory agent, and antiemetics

Malignant bowel obstruction is managed with opioids for pain/colic, antisecretory agents (e.g., octreotide or hyoscine) to reduce secretions, and antiemetics.

An AOCNP is counseling the family of a dying patient about the 'death rattle.' Which statement is most accurate?

Answer: It is caused by retained secretions and is usually not distressing to the patient

The death rattle results from retained oropharyngeal secretions in a semi-comatose patient and is typically not distressing to the patient, though it may distress families.

Which tool is specifically validated for assessing symptom burden in patients with advanced cancer across multiple symptom domains?

Answer: Edmonton Symptom Assessment System (ESAS)

The Edmonton Symptom Assessment System (ESAS) is a validated, multidimensional tool that rates nine common symptoms (pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, wellbeing, dyspnea) in palliative patients.