COCN COCN Palliative and End-of-Life Care 2

Question 1

Which opioid rotation (equianalgesic conversion) consideration is most important when switching a cancer patient from morphine to hydromorphone?

Accepted Answer

A 25–50% dose reduction from the calculated equianalgesic dose is recommended to account for incomplete cross-tolerance

Answer

Hydromorphone requires a higher dose than morphine

Answer

No dose adjustment is needed since opioids are interchangeable

Answer

Hydromorphone should only be used IV, never subcutaneously

Question 2

A cancer patient on chronic opioids develops constipation. The first-line treatment is:

Accepted Answer

Stimulant laxatives (senna) with or without stool softeners

Answer

Bulk-forming laxatives (psyllium)

Answer

Increased oral fluid intake alone

Answer

Fiber supplements only

Question 3

Which medication is specifically FDA-approved for opioid-induced constipation in cancer patients who have not responded to standard laxatives?

Accepted Answer

Methylnaltrexone (Relistor)

Answer

Metoclopramide

Answer

Ondansetron

Answer

Lactulose

Question 4

A patient with advanced cancer is experiencing refractory dyspnea. The evidence-based pharmacologic treatment is:

Accepted Answer

Low-dose systemic opioids

Answer

Benzodiazepines as monotherapy

Answer

High-dose corticosteroids only

Answer

Bronchodilators regardless of pulmonary cause

Question 5

Which advance directive specifically designates a person to make healthcare decisions if the patient becomes incapacitated?

Accepted Answer

Durable power of attorney for healthcare (DPAHC)

Answer

Living will

Answer

POLST/MOLST form

Answer

DNR order

Question 6

Palliative sedation for refractory symptoms at end of life requires that other symptom management options have been:

Accepted Answer

Exhausted or deemed inappropriate before sedation is initiated

Answer

Not yet tried to conserve resources

Answer

Refused by the family but not the patient

Answer

Only tried once each