COCN COCN Palliative and End-of-Life Care 1 — Questions and Answers
Question 1: Palliative care differs from hospice care in that palliative care:
- Is only provided in the final weeks of life
- Can be provided at any stage of cancer alongside curative treatment (Correct answer)
- Is exclusively for patients who have stopped treatment
- Requires a prognosis of less than 6 months
Correct answer: Can be provided at any stage of cancer alongside curative treatment
Palliative care focuses on quality of life and symptom management and can be integrated with curative cancer treatment at any disease stage.
Question 2: A patient with terminal cancer refuses further treatment and asks about hospice. Medicare hospice benefit requires a physician-certified prognosis of life expectancy of:
- 3 months or less
- 6 months or less if the disease runs its normal course (Correct answer)
- 12 months or less
- 1 month or less
Correct answer: 6 months or less if the disease runs its normal course
Medicare hospice eligibility requires physician certification that life expectancy is 6 months or less if the illness follows its expected course.
Question 3: Which ethical principle underlies a patient's right to refuse cancer treatment, including life-sustaining measures?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Non-maleficence
Correct answer: Autonomy
Autonomy is the ethical principle affirming patients' right to make informed decisions about their own care, including refusal of treatment.
Question 4: The nursing concept of 'total pain' in palliative care encompasses which dimensions?
- Physical pain only
- Physical, psychological, social, and spiritual suffering (Correct answer)
- Nociceptive and neuropathic pain only
- Acute and chronic physical pain
Correct answer: Physical, psychological, social, and spiritual suffering
Dame Cicely Saunders defined 'total pain' as encompassing physical, psychological, social, and spiritual components of suffering.
Question 5: Which scale is most widely used by oncology nurses to assess pain intensity in cognitively intact adult patients?
- Wong-Baker FACES scale
- Numeric Rating Scale (NRS) 0–10 (Correct answer)
- FLACC scale
- Abbey pain scale
Correct answer: Numeric Rating Scale (NRS) 0–10
The 0–10 Numeric Rating Scale is the most widely validated and recommended pain intensity tool for cognitively intact adults.
Question 6: A dying patient develops the 'death rattle' (noisy breathing). The most appropriate nursing intervention is:
- Aggressive suctioning to clear secretions
- Repositioning and anticholinergic medications to reduce secretions (Correct answer)
- Increasing IV fluid rates to thin secretions
- Placing the patient in Trendelenburg position
Correct answer: Repositioning and anticholinergic medications to reduce secretions
Repositioning reduces pooling of secretions, and anticholinergics (e.g., glycopyrrolate) decrease secretion production with minimal distress to the patient.
COCN COCN Palliative and End-of-Life Care 1
Palliative care differs from hospice care in that palliative care: