CT Hospice & Palliative Principles 3 — Questions and Answers
Question 1: In the final hours of life, which respiratory pattern is characterized by alternating periods of apnea and hyperpnea?
- Kussmaul breathing
- Cheyne-Stokes respiration (Correct answer)
- Biot's breathing
- Tachypnea
Correct answer: Cheyne-Stokes respiration
Cheyne-Stokes respiration, common near death, features cyclical crescendo-decrescendo breathing alternating with apneic pauses.
Question 2: Which ethical principle is MOST directly upheld when a hospice patient completes a POLST (Physician Orders for Life-Sustaining Treatment) form?
- Beneficence
- Non-maleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
POLST translates a patient's wishes into actionable medical orders, directly honoring the principle of patient autonomy.
Question 3: A palliative care team is caring for a patient with refractory dyspnea. Evidence-based first-line pharmacological management includes:
- Benzodiazepines alone
- Supplemental oxygen for all patients
- Low-dose systemic opioids (Correct answer)
- Bronchodilators regardless of diagnosis
Correct answer: Low-dose systemic opioids
Low-dose opioids are the evidence-based first-line treatment for refractory dyspnea in palliative care, reducing the subjective sensation of breathlessness.
Question 4: Which of the following BEST describes 'anticipatory grief'?
- Grief that is pathological because it begins before the actual death
- Mourning that occurs in advance of an expected loss, experienced by patients and families (Correct answer)
- A clinical syndrome requiring psychiatric intervention
- Grief that is shorter in duration because mourning began early
Correct answer: Mourning that occurs in advance of an expected loss, experienced by patients and families
Anticipatory grief is a normal response to an impending loss, allowing patients and families to begin processing the death before it occurs.
Question 5: Which statement BEST differentiates hospice care from general palliative care?
- Palliative care is only provided in hospitals, while hospice is only at home
- Hospice requires a prognosis of 6 months or less and focuses solely on comfort, while palliative care can begin at any illness stage alongside curative treatment (Correct answer)
- Hospice includes curative treatment options, while palliative care does not
- Palliative care is reimbursed by Medicare, while hospice is not
Correct answer: Hospice requires a prognosis of 6 months or less and focuses solely on comfort, while palliative care can begin at any illness stage alongside curative treatment
Hospice is a specific program for those with a terminal prognosis who forgo curative treatment, whereas palliative care is a broader approach applicable at any disease stage.
Question 6: When a hospice patient develops delirium in the final days of life, the family is distressed by the patient's agitation. The MOST appropriate intervention is:
- Immediately begin physical restraints to prevent injury
- Educate the family that terminal delirium is common, and consider pharmacological management with haloperidol (Correct answer)
- Increase opioid doses significantly to sedate the patient
- Transfer the patient to an inpatient psychiatric unit
Correct answer: Educate the family that terminal delirium is common, and consider pharmacological management with haloperidol
Family education about terminal delirium, combined with low-dose haloperidol for agitation, is the evidence-based approach for managing this common end-of-life syndrome.
Question 7: The National Hospice and Palliative Care Organization (NHPCO) Standards require that bereavement services be provided to the family for at least how long after the patient's death?
- 3 months
- 6 months
- 12 months (Correct answer)
- 18 months
Correct answer: 12 months
NHPCO standards mandate that hospice programs provide bereavement support to surviving family members for at least 13 months (one year plus one month) following the patient's death.
CT Hospice & Palliative Principles 3
In the final hours of life, which respiratory pattern is characterized by alternating periods of apnea and hyperpnea?