614 exam 2 Buttaro
1. When should palliative care be initiated by a primary care provider? a.
After an ill patient asks for Hospice services b. As part of routine health
maintenance c. When a patient is diagnosed with a serious disease d.
When an interdisciplinary team is formed to manage a disease
ANS: B Palliative care support begins with an understanding of a
patient's preferences and helping the patient to identify goals of care.
Health care providers should initiate such discussions as a component of
the initial history of adults regardless of age or health status. Palliative
care services may be ordered when a patient is diagnosed with a serious
disease; waiting until the patient asks for Hospice services or when an
interdisciplinary team is formed increases the chances of providing
end-of-life care that does not meet the patient's needs
MULTIPLE RESPONSE 1. When using the "Five Wishes" approach to
documenting patient preferences for end-of-life care, the provider will
document which types of preferences? (Select all that apply.) a. A
directive to avoid calling 911 at the time of death b. A specific list of
treatments the patient does not want c. How much information to give
various family members d. The level of sedation versus alertness the
patient desires e. The people designated to make care decisions for the
patient
ANS: C, D, E The Five Wishes approach addresses the type of care a
patient wants as a disease progresses and is less defensive than the
traditional advance directive which indicates the type of care a patient
does not want. Calling 911 may be done without requiring resuscitation if
the patient has an appropriate advanced directive in place.
A patient who is near death is exhibiting signs of agitation, anxiety, and
intractable pain. When discussing palliative sedation with this patient's
family, what will be discussed? (Select all that apply.) a. The chance that
refractory symptoms will be alleviated b. The fact that this is an
intervention of last resort c. The likelihood that the patient will develop
dependence on the drugs d. The need for informed consent from the
patient and family e. The possibility that this measure may hasten death
, ANS: B, D, E Palliative sedation is used as a treatment of last resort for
patients whose symptoms are intolerable or refractory. Patients, if
possible, and family members must give informed consent. This
treatment has the possibility of hastening death by inhibiting respirations.
Symptoms will not be alleviated by using the measure. The chance of
drug dependence is irrelevant in this situation.
1. A patient who has chronic lower back pain reports increased difficulty
sleeping unrelated to discomfort, along with a desire to quit working.
What will the provider do? a. Ask the patient about addiction issues. b.
Consult with a social worker. c. Increase the dosage of prescribed pain
medications. d. Order radiographic studies of the lower spine.
ANS: B Patients who exhibit poor sleep and poor coping may be
developing mental defeat as a result of chronic pain and should be
evaluated and treated early for this to prevent further disability and
improve functionality. Substance abuse may be a part of mental defeat
and should be evaluated based on assessment findings. Unless the
symptoms are related to pain, increasing the dose of analgesics and
ordering diagnostic studies are not indicated.
2. A patient with chronic leg pain describes the pain as "stabbing" and
"throbbing." This is characteristic of which type of pain? a. Neuropathic
pain b. Referred pain c. Somatic pain d. Visceral pain
ANS: C Somatic pain is caused by the activation of nociceptors in the
peripheral tissues, including skin, bones, muscles, and soft tissue and is
usually well-localized and characterized as stabbing, aching, or
throbbing. Neuropathic pain occurs from injury to or disease of the
nervous system and is described as burning, shooting, or tingling.
Referred pain is a kind of visceral pain that is localized, but not
attributable to the involved organ. Visceral pain is related to an organ
and is often referred and poorly localized
3. A patient is beginning treatment for chronic pain and is unable to
tolerate nonsteroidal anti-inflammatory drugs. What will the provider
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