The best form of palliative care delivery is provided by:

Select one:

a.
Palliative care specialists only

b.
Community health workers with or without supervision

c.
A team of health professionals who, together, have the appropriate training to respond to the needs of
patients and their families.

d.
Primary care physicians

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Correct answer

The correct answer is: A team of health care professionals who, together, have the appropriate training to
respond to the needs of patients and their families.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

What do palliative care services include?

Select one:

a.
Assistance to the dying

b.
Psychological support to patients

c.
Evaluation and treatment of symptoms

d.
Bereavement support for families after a patient has passed away

e.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

The WHO definition of palliative care states that palliative care aims to:

Select one:

a.
Prolong the patient's life as long as possible.

b.
Discontinue all further treatment of the disease

c.
Improve the patient's quality of life

d.
Accelerating the death process

Feedback

Correct answer
The correct answer is: To improve the patient's quality of life.

Question4
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements is an accurate description of the relationship between

palliative care and end-of-life care?

Select one:

a.
Palliative care and end-of-life care are the same: both focus on the care of the dying person.

b.
Supportive care for cancer patients is referred to as palliative care. End-of-life care is defined as care at
the end of life in any disease.

c.
Palliative care is the response to the suffering of any patient with a serious or life-threatening illness. End-
of-life care is also focused on a response to suffering, but more specifically for patients nearing the end
of life.

Feedback

Correct answer

The correct answer is: Palliative care is the response to the suffering of any patient with a serious or life-
threatening illness. End-of-life care is also focused on a response to suffering, but more specifically for
patients nearing the end of life.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

According to the 2014 Declaration of the World Health Assembly, palliative care is:

Select one:

a.
An optional service that can be provided, but is not essential

b.
An important service that should be provided wherever possible

c.
A necessary service whose provision is an ethical duty of all health professionals.

d.
Too costly and should not be considered a priority over other more essential health services.

Feedback

Correct answer

The correct answer is: A necessary service whose provision is an ethical duty of all health professionals.

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding access to morphine for palliative care patients,on average worldwide:

Select one:

a.
Access to morphine is excessively high and international experts recommend measures to restrict it
further

b.
Access to morphine is adequate. Patients in need of palliative care can usually be treated with morphine
when they need it.

c.
Access to morphine is too low and international experts recommend steps to increase it for palliative
care patients

Feedback

Correct answer

The correct answer is: Access to morphine is too low and international experts recommend taking steps
to increase it for palliative care patients.

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following types of suffering experienced by patients and their families is palliative
care intended to address?

Select one:

a.
Physical suffering

b.
Psychological suffering

c.
Social suffering

d.
Spiritual suffering

e.
All of the above

Feedback

Correct answer
The correct answer is: All of the above

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

At what point in a patient's subsequent cancer progression would it be most appropriate to

begin the provision of palliative care?

Select one:

a.
At the time of diagnosis

b.
At the time the cancer-directed treatment is initiated

c.
At the moment the cancer metastasizes

d.
At the time of discontinuation of cancer-directed treatment

Feedback

Correct answer

The correct answer is: At the time of diagnosis.

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

For which patient populations are palliative care services most appropriate?

Select one:

a.
Patients at the end of life

b.
Cancer patients

c.
Patients with any serious illness who are experiencing physical, psychological, social or spiritual suffering.

d.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question10
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

When palliative care services are initiated for a patient, it is usual for the patient's curative
treatments:

Select one:

a.
Be discontinued, since the objectives of palliative care are usually not compatible with the application of
more curative treatment.

b.
Be continued, as palliative care may in fact improve the outcomes of curative treatment plans by
providing better symptom control and overall treatment compliance
c.
Be discontinued, because palliative care interventions may worsen the effect of curative treatments.

Feedback

Correct answer

The correct answer is: Be continued, as palliative care can actually improve the outcomes of curative
treatment plans by providing better symptom control and overall treatment compliance.

When assessing pain, the most reliable method of measurement is:

Select one:

a.
An increase in heart rate

b.
An increase in blood pressure

c.
Subjective evaluation, asking the patient to rate the pain on a scale of 0 to 10.

d.
An increase in respiratory rate

Feedback

Correct answer

The correct answer is: The subjective evaluation, asking the patient to rate the pain he/she has on a scale
of 0 to 10.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which statement is true regarding general approaches to treating pain?

Select one:
a.
Differential diagnosis with respect to the underlying cause is not important.

b.
Treatment of severe pain should be delayed so that diagnostic tests can be performed first.

c.
Only opioids should be administered as first-line treatment.

d.
The method of treatment should be attempted to be consistent with the underlying cause of the pain.

Feedback

Correct answer

The correct answer is: The method of treatment should be attempted to be consistent with the
underlying cause of the pain.

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding pain assessment in pediatric patients, which of the following statements is true?

Select one:

a.
Infants and newborns do not suffer pain because their neurological system is still underdeveloped.

b.
The use of morphine and other opioids is dangerous and should therefore be avoided in children under
12 years of age.

c.
Nonverbal signs, such as facial expressions and crying, can be used to assess pain in children who are too
young to talk.
Feedback

Correct answer

The correct answer is: Nonverbal signs, such as facial expressions and crying, can be used to assess pain
in children who are too young to talk.

Question4
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following behaviors is most likely to be an indicative sign that a patient may be
addicted to opioids?

Select one:

a.
A cancer patient in whom sweating and diarrhea occur when morphine administration, which she has
been receiving for the previous 3 months, is abruptly discontinued.

b.
A patient with a cancer in stable condition who has required an increase in morphine doses every 2-3
months to continue to obtain the same analgesic effect.

c.
A cancer patient who continues to use higher doses of morphine than prescribed by her health care
professional and frequently comes to the office to ask for an earlier prescription refill because she has
lost her medications

d.
A cancer patient who has been on opioids for her cancer for many years and continues to explain to the
health care professional that she has 8/10 pain despite appearing to be quite comfortable during the
office visit

Feedback

Correct answer
The correct answer is: A cancer patient who continues to use higher doses of morphine than prescribed
by her health care professional and who frequently comes to the office to ask for an early prescription
refill because she has lost her medications.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

If a patient is unable to speak because of confusion or advanced neurological disease, which of

the following statements is correct regarding the best way to assess and treat pain?

Select one:

a.
If a patient is not able to say they are in pain, they are unlikely to be in severe pain and therefore do not
require a pain assessment and treatment plan.

b.
If a patient's degree of confusion is so high that he/she is unable to describe the pain he/she is
experiencing, it would be dangerous to use pain medication, as it could further aggravate the confusion.

c.
When a patient is unable to tell that he or she is in pain, other nonverbal cues, such as breathing
patterns, facial expressions, and body language, can be used to assess and treat pain.

Feedback

Correct answer

The correct answer is: When a patient is not able to tell that he or she is in pain, other nonverbal cues,
such as breathing patterns, facial expressions, and body language, can be used to assess and treat pain.

Question6
Correct
Scores 1.00 out of 1.00

Check question
Statement of the question

The use of a 0 to 10 scale to assess pain is useful in palliative care patients because:

Select one:

a.
Helps to compare pain levels of different patients

b.
Helps to determine whether a patient's pain is real or not

c.
Helps measure changes in a particular patient's pain level over time

Feedback

Correct answer

The correct answer is: It helps to measure changes in a particular patient's pain level over time.

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

When assessing a patient's pain, what characteristics are important to ask about?

Select one:

a.
The chronology of the pain (when did it start, how often does it appear, how long does it last)?

b.
The location of the pain (where does it occur, does it radiate elsewhere?)

c.
The character of the pain (is it a living pain, a dull ache, something akin to burning?)

d.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Who can best describe a patient's pain?

Select one:

a.
The patient

b.
The primary care physician

c.
The International Association for the Study of Pain

d.
The nurses

Feedback

Correct answer

The correct answer is: The patient

Question9
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

If a patient with widely metastatic cancer indicates that he or she has a pain intensity of 8/10,
but appears to be resting comfortably in bed during the visit, this most likely indicates the
following:

Select one:

a.
It is possible that the patient is addicted to morphine and is misrepresenting his degree of pain in an
attempt to obtain an increase in dose

b.
The patient does not understand the pain scale and it would be beneficial to re-explain how the 0 to 10
scale works.

c.
Patient has uncontrolled pain and requires reassessment and adjustment of treatment plan with
analgesia

Feedback

Correct answer

The correct answer is: The patient has uncontrolled pain and requires reassessment and adjustment of
the treatment plan with analgesia.

Question10
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

When performing an initial assessment for palliative care, if the patient is in severe pain, the
first thing to do is:

Select one:
a.
Complete the full assessment as you cannot safely respond to the patient's pain until a detailed
assessment has been completed.

b.
Conduct a very brief initial assessment to guide an initial treatment plan, and complete a detailed
assessment later when the patient is more comfortable.

c.
Complete a thorough evaluation and also wait for the results of further laboratory tests or imaging scans,
as it is dangerous to treat a patient's pain before establishing a clear diagnosis.

Feedback

Incorrect answer.

The correct answer is: Conduct a very brief initial assessment to guide an initial treatment plan, and
complete a detailed assessment later when the patient is more comfortable.

MODULE 3

Question1
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

When considering increasing a basal amount of opioid, how much of the daily intake on an as-
needed basis is safe and most useful to include in the basal administration?

Select one:

a.
10%-20%

b.
25%-50%

c.
50%-100%

d.
100%-200%

e.
300%

Feedback

Correct answer

The correct answer is: 50%-100%.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

When starting opioid treatment, it is important to consider all of the following factors EXCEPT:

Select one:

a.
Renal and liver function

b.
Patient's age

c.
Patient's race
d.
Concurrent use of other medications

Feedback

Correct answer

The correct answer is: The patient's race

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

You visit a patient in the palliative care office who has been referred because of worsening
cancer-related pain. The patient has never taken opioids before and you decide to start
treatment with oral short-acting morphine on an as-needed basis. What may be a good dosing
interval to initiate oral morphine administration in a patient who has not previously received
opioid treatment?

Select one:

a.
1-2 mg orally every 4 hours according to needs

b.
5-10 mg orally every 4 hours according to needs

c.
20-30 mg orally every 4 hours according to needs

d.
40-50 mg orally every 4 hours according to needs

e.
50-100 mg orally every 4 hours according to needs

Feedback

Correct answer
The correct answer is: 5-10 mg orally every 4 hours as needed.

Question4
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements is true regarding the use of short-acting opioids?

Select one:

a.
It is recommended for use as an initial opioid in patients who have never been given opioids before.

b.
They are not useful for incidental pain control.

c.
The preferred route of administration is intravenous.

d.
If, after administration of the drug, the pain persists without relief, the same dose is repeated 4 hours
later.

Feedback

Correct answer

The correct answer is: It is recommended for use as an initial opioid in patients who have never been
given opioids before.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

You are caring for a patient with a diagnosis of prostate cancer in whom bone pain secondary
to vertebral metastasis has appeared. For the past 7 days, the patient has been treated with 5
mg of morphine 3 or 4 times a day, and this has significantly relieved the pain. However, he
now refers constipation in the last 4 days. What is the correct recommendation?

Select one:

a.
Start administration of docusate sodium once a day.

b.
Begin administration of senna in doses of 1 tablespoon orally twice a day.

c.
Explain to the patient that he/she should not worry, since constipation secondary to opioids is a
transitory effect.

d.
Discontinue morphine administration as it is likely to be the cause of the patient's constipation.

Feedback

Correct answer

The correct answer is: Start senna administration at a dose of 1 tablespoon orally twice a day.

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following opioids is the least preferable in the presence of renal failure?

Select one:

a.
Hydromorphone

b.
Morphine
c.
Fentanyl

d.
Methadone

Feedback

Correct answer

The correct answer is: Morphine

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

You are caring for a patient with esophageal cancer and bone metastases. The patient has
been taking hydromorphone orally up to 6 times a day for pain control and has difficulty
swallowing the medications. You decide to start using a fentanyl patch. After calculating the
oral morphine equivalents of the hydromorphone he takes, he establishes that he has been
receiving the equivalent of 75 mg of oral morphine per day. Considering the existence of
incomplete cross-tolerance, what is the appropriate dose to start this patient on fentanyl
patches?

Select one:

a.
12 mcg/hour

b.
25 mcg/hour

c.
37 mcg/hour

d.
50 mcg/hour

e.
75 mcg/hour

Feedback

Correct answer

The correct answer is: 25 mcg/hour.

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

You work as a hospital palliative care specialist. You are paged to see a patient presenting with
a pain crisis. You know that an intravenous opioid will be more effective than an oral opioid in
controlling this patient's pain and you decide to switch from oral morphine to intravenous
morphine. What is the dose ratio of oral morphine to intravenous morphine?

Select one:

a.
3:1

b.
5:1

c.
7:1

d.
10:1

e.
20:1

Feedback

Correct answer
The correct answer is: 3:1

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements is true regarding the use of long-acting opioids?

Select one:

a.
It is recommended for use as an initial opioid in patients who have never been given opioids before.

b.
Useful for incidental pain control

c.
Once started, the patient should not receive short-acting opioids.

d.
The dose should be calculated according to the short-acting opioid dose required by the patient.

Feedback

Correct answer

The correct answer is: The dose should be calculated according to the dose of short-acting opioids
required by the patient.

Question10
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements is correct regarding the appropriate way to increase opioid
dosage over time?

Select one:

a.
If more than 3 doses administered as needed within 24 hours are necessary, 50%-100% of the rescue
dose should be added to the total daily dose of long-acting opioid.

b.
If the patient needs at least one additional dose administered on demand, the basal dose of opioid
should be increased.

c.
There is a defined maximum dose for each opioid.

d.
Opioid doses should be increased until pain is controlled, regardless of the presence of intolerable side
effects.

Feedback

Correct answer

The correct answer is: If more than 3 doses administered as needed within 24 hours are necessary, 50%-
100% of the rescue dose should be added to the total daily dose of long-acting opioid.

Module 4

Question1
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

When assessing dyspnea, the most reliable method of measurement is:

Select one:

a.
A decrease in oxygen saturation
b.
An increase in respiratory rate

c.
An increase inCO2 measured in an arterial blood gas analysis.

d.
A subjective assessment by asking the patient to rate their dyspnea / shortness of breath on a scale of 0
to 10.

Feedback

Correct answer

The correct answer is: A subjective assessment by asking the patient to rate their dyspnea / shortness of
breath on a scale of 0 to 10.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Your patient comes to the palliative care office for follow-up treatment of her symptoms. She
has thyroid cancer with pulmonary metastases and has suffered from severe dyspnea. He
explains that he finds relief by putting his face in front of a fan. What is the mechanism of
action of air giving in the face for the relief of dyspnea?

Select one:

a.
Provides more oxygen

b.
Stimulates trigeminal nerve receptors

c.
Lowers the humidity of the air
d.
Purifies the air the patient breathes

Feedback

Correct answer

The correct answer is: Stimulates trigeminal nerve receptors.

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following is a strategy for the management of refractory nausea and vomiting?

Select one:

a.
Rotation to move to a different drug in the same drug class

b.
Increase the dosage of the chosen drug

c.
Ensure that the patient is taking the medication on a regular basis and as needed

d.
Further investigate whether there are new causes of nausea.

e.
All of the above strategies can be effective

Feedback

Correct answer

The correct answer is: All of the above strategies can be effective.

Question4
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

You are caring for a woman with metastatic ovarian cancer. The patient has peritoneal
metastases and comes to the hospital for severe abdominal pain with nausea and vomiting.
You suspect and subsequently confirm that you have a malignant bowel occlusion. Which of
the following medications would be most helpful in treating pain and nausea/vomiting?

Select one:

a.
Dexamethasone

b.
Morphine

c.
Lorazepam

d.
Haloperidol

Feedback

Correct answer

The correct answer is: Dexamethasone.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

What class of drugs is the gold standard for the treatment of refractory dyspnea?

Select one:
a.
Benzodiazepines

b.
Neuroleptics

c.
Opioids

d.
Anticoagulants

e.
Diuretics

Feedback

Correct answer

The correct answer is: Opioids

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding the use of oxygen therapy for the control of dyspnea, which of the following
statements is correct?

Select one:

a.
It can sometimes provide moderate relief, but is rarely effective in severe dyspnea.

b.
It is the most important element of a dyspnea treatment plan.
c.
It should be applied under the guidance of a constant goal of maintaining O2 saturation above95% in all
patients.

d.
Dosage should be adjusted by frequent arterial blood gas determinations to achieve the most effective
relief of dyspnea.

Feedback

Correct answer

The correct answer is: It can sometimes provide moderate relief, but is rarely effective in severe dyspnea.

Question7
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

The primary cause of dyspnea in most palliative care patients is:

Select one:

a.
Hypoxemia (low oxygen levels)

b.
Hypercapnia (highCO2 levels)

c.
Increased anxiety causing higher respiratory rate

d.
Multifactorial, usually due to a combination of physiological and psychological factors

Feedback

Incorrect answer.

The correct answer is: Multifactorial, usually due to a combination of physiological and psychological
factors.
Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following drug-receptor pairings isincorrect?

Select one:

a.
Diphenhydramine - serotonin

b.
Haloperidol - dopamine

c.
Ondansetron - serotonin

d.
Metoclopramide - dopamine

Feedback

Correct answer

The correct answer is: Diphenhydramine - serotonin.

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following istrue about dyspnea?

Select one:
a.
Only occurs in pulmonary diseases

b.
Worsens during the dying process

c.
It is an objective sign and not a subjective symptom.

d.
Does not exist without hypoxemia

Feedback

Correct answer

The correct answer is: It gets worse during the dying process.

Question10
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

You have an office visit with a patient who has hepatocellular carcinoma. The patient had been
nauseated and you had prescribed an antiemetic at his last visit. The patient explains to you
that, since he started taking the antiemetic, he has had more constipation. Which of the
following medications are you likely to be taking already, and do you have constipation as a
frequent side effect?

Select one:

a.
Haloperidol

b.
Ondansetron
c.
Prochlorperazine

d.
Metoclopramide

e.
Dexamethasone

Feedback

Incorrect answer.

The correct answer is: Ondansetron

Module 5

Question1
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Patients with untreated major depression:

Select one:

a.
They have the same risk of death as the general population.

b.
Have an increased risk of cardiac arrhythmia

c.
Rarely do they present anxiety at the same time

d.
They have a higher pain tolerance than the general population.

Feedback
Correct answer

The correct answer is: They have an increased risk of cardiac arrhythmia.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

The following statements about the psychological distress of the terminally ill are TRUE,
EXCEPT:

Select one:

a.
May reduce the ability to connect with others

b.
Its treatment improves the quality of life of patients and their families.

c.
May cause distress to family and friends

d.
It is impossible to differentiate normal sadness from psychopathology at the end of life.

Feedback

Correct answer

The correct answer is: It is impossible to differentiate normal sadness from psychopathology at the end
of life.

Question3
Correct
Scores 1.00 out of 1.00

Check question
Statement of the question

Cancer patients with cachexia experience all of the following changes EXCEPT:

Select one:

a.
Reduced physical capacity

b.
Worst prognosis

c.
Lower quality of life

d.
Lower cognitive capacity

e.
Decreased ability to tolerate targeted cancer therapies

Feedback

Correct answer

The correct answer is: Lower cognitive capacity.

Question4
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

The following statement about psychiatric symptoms in terminally ill patients is TRUE:

Select one:

a.
They can only occur if the patient already had a previous psychiatric illness.

b.
They are always part of the dying process

c.
They are frequent but can usually be alleviated

d.
It is not necessary to treat them

Feedback

Incorrect answer.

The correct answer is: They are frequent but can usually be alleviated.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Psychological distress in a terminally ill patient can:

Select one:

a.
Amplifying pain

b.
Reduced ability to say goodbye to family and friends

c.
Increasing the risk of suicide

d.
All of the above

Feedback

Correct answer
The correct answer is: All of the above

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

When treating a patient with worsening cachexia, which of the following would be the most
appropriate first step in treatment?

Select one:

a.
Begin megestrol acetate administration

b.
Start corticosteroids administration

c.
Begin administration of cannabinoids

d.
Consider possible reversible causes, such as mood disorders or side effects of medications

Feedback

Correct answer

The correct answer is: Consider possible reversible causes, such as mood disorders or side effects of
medications.

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

You see a 36-year-old woman with newly diagnosed metastatic breast cancer who reports
difficulty sleeping and anxiety about the future. Shall:

Select one:

a.
Immediately refer her to a psychiatrist.

b.
Prescribing haloperidol to help you sleep

c.
Conduct a psychological, social and spiritual assessment

d.
Immediate prescription of diazepam for anxiety

Feedback

Correct answer

The correct answer is: Conduct a psychological, social and spiritual assessment.

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

A 57-year-old woman with metastatic pancreatic cancer is diagnosed with major depression.
Which of the following would be the most reasonable first choice medication to treat your
depression?

Select one:

a.
Haloperidol

b.
Sertraline
c.
Lorazepam

d.
Gabapentin

Feedback

Correct answer

The correct answer is: Sertraline

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

In a patient with a medical illness, the following symptoms are indicators of major depression
EXCEPT:

Select one:

a.
Feeling useless

b.
Inability to experience any pleasure

c.
Hope for a cure

d.
Thoughts about suicide

Feedback

Correct answer

The correct answer is: Hope for a cure.

Question10
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

Regarding the evidence regarding artificial nutrition and hydration, which of the following
statements is correct?

Select one:

a.
It is recommended in most cachectic patients because their nutritional status is often easily improved
with the use of artificial nutrition.

b.
It should be used in most cancer patients because it has been observed to prolong survival.

c.
It should not be used as a method of preventing pressure ulcers, as it has not been found to be effective
in preventing pressure ulcers.

Feedback

Incorrect answer.

The correct answer is: It should not be used as a method of preventing pressure ulcers, as it has not been
found to be effective in preventing pressure ulcers.

Question1
Correct
Scores 1.00 out of 1.00

Check question
Statement of the question

Which of the following statements about a normal grief reaction is FALSE?

Select one:

a.
It is an almost universal experience

b.
Does not last more than 6 months

c.
Only occurs in people with a mental illness.

d.
Its manifestations may be different in different cultures

Feedback

Correct answer

The correct answer is: It only occurs in people with a mental illness.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

All of the following are part of a psychosocial assessment EXCEPT:

Select one:

a.
Level of uneasiness

b.
Family functionality

c.
Pain control

d.
Advance instructions

Feedback

Correct answer

The correct answer is: Pain control

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

After the death of a loved one, most family members:

Select one:

a.
They need professional psychological help

b.
Need an antidepressant

c.
They make a profit with the support of family and friends.

d.
Suicide contemplated

Feedback

Correct answer

The correct answer is: They make a profit with the support of family and friends.

Question4
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

Which of the following should be avoided in the spiritual care plan?

Select one:

a.
Imposing one's own religious beliefs on the patient

b.
Therapeutic communication interventions

c.
Therapies oriented to the meaning of life

d.
Connect the patient to community resources.

Feedback

Correct answer

The correct answer is: To impose one's religious beliefs on the patient.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements is FALSE?

Select one:

a.
Spiritual care is always provided by a priest.
b.
Spirituality and religion reduce depression and anxiety

c.
Lack of time is one of the obstacles identified for the provision of spiritual care.

d.
The loss of a loved one or the loss of a previous state of health can trigger spiritual distress

Feedback

Correct answer

The correct answer is: Spiritual care is always provided by a priest.

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following is part of the psychosocial support provided to palliative care patients?

Select one:

a.
Exploration of the patient's values, hopes and fears.

b.
Emotional support to help patients and their families cope with a serious illness

c.
Bereavement support for bereaved family members

d.
All of the above

Feedback
Correct answer

The correct answer is: All of the above

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements about normal grief is FALSE?

Select one:

a.
Uneasiness decreases with the passage of time

b.
Sadness occurs on dates close to the anniversary of death

c.
Family members stop thinking about the deceased within a few months

d.
Acceptance of loss occurs with the passage of time

Feedback

Correct answer

The correct answer is: Family members stop thinking about the deceased within a few months.

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

His patient passed away 5 weeks ago due to terminal liver disease and today his previously
healthy wife came to him for help with her insomnia. She also refers to feelings of sadness and
anger, crying episodes and visions of her deceased husband. It is very likely that you are
experiencing the following:

Select one:

a.
Normal grief reaction

b.
Severe depression

c.
Dementia

d.
Post-traumatic stress disorder

Feedback

Correct answer

The correct answer is: Normal grief reaction.

Question9
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

One of the following isnot a risk factor for abnormal affliction:

Select one:

a.
Death of a child

b.
History of psychiatric problems
c.
History of childhood abuse/neglect

d.
Concern with thoughts and memories of the deceased

Feedback

Incorrect answer.

The correct answer is: Uneasiness with thoughts and memories of the deceased.

Question10
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Anticipatory grief:

Select one:

a.
Occurs after the death of a family member

b.
Allows family members to prepare psychologically for the death of a family member

c.
Often leads to requests for euthanasia

d.
It is abnormal and should be treated with antidepressants.

Feedback

Correct answer

The correct answer is: It allows family members to prepare psychologically for the death of a family
member.
Question1
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

The principle of beneficence means:

Select one:

a.
Avoid damaging

b.
Try to help the patient

c.
Treating all people equally

d.
The right of assistance providers to do so in the manner that is most beneficial to them.

Feedback

Incorrect answer.

The correct answer is: Try to help the patient.

Question2
Incorrect
Score 0.00 out of 1.00

Check question

Statement of the question

Julia is an 80-year-old patient and has just been diagnosed with metastatic colon cancer. Her
husband is very concerned because the patient has a history of depression and asks the
physician NOT to mention the new diagnosis to the patient. In such a case, what ethical
principles conflict?

Select one:

a.
Autonomy in the face of justice. The physician wants to respect the patient's autonomy but the husband
does not consider that she should be informed

b.
Autonomy versus nonmaleficence. The doctor wants to respect the patient's autonomy, and the husband
is concerned about the harm that the information may cause him.

c.
Autonomy per se. The physician has to inform the patient despite the husband's concern.

d.
Non-maleficence per se. The husband is right, because this information could only cause harm if
communicated to the patient.

Feedback

Incorrect answer.

The correct answer is: Autonomy versus nonmaleficence. The doctor wants to respect the patient's
autonomy, and the husband is concerned about the harm that the information may cause him.

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

The principle of non-maleficence means:

Select one:

a.
Avoid damaging
b.
Life is not only a social good, but also a personal good.

c.
Treating all people equally

d.
Doing good and avoiding evil

Feedback

Correct answer

The correct answer is: Avoid damaging

Question4
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following explanations best defines the ethical principle of double effect?

Select one:

a.
Medications intended to provide relief of severe pain or other symptoms may be used even if they carry a
risk of anticipated but unintended side effects.

b.
Whenever a caregiver's intention is to help a patient, he/she should not be held liable for any
complications that may occur.

c.
When two different principles conflict, you should always respect the one that is more important to the
patient.

d.
It is correct to seek to hasten the death of a patient as long as the patient has given his or her prior
consent to do so

Feedback

Correct answer

The correct answer is: Medications intended to provide relief of severe pain or other symptoms may be
used even if this involves a risk of anticipated but unintended side effects.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

The four basic principles of medical ethics are:

Select one:

a.
Beneficence, justice, independence, nonmaleficence

b.
Human rights, autonomy, freedom, justice

c.
Beneficence, malfeasance, dignity, human rights

d.
Beneficence, non-maleficence, justice, autonomy

Feedback

Correct answer

The correct answer is: Beneficence, non-maleficence, justice, autonomy.

Question6
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

When a patient chooses not to undergo an intervention recommended by his or her physician,
this illustrates one of the following ethical principles:

Select one:

a.
Charity

b.
Justice

c.
Autonomy

d.
Non-maleficence

Feedback

Correct answer

The correct answer is: Autonomy

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding the approach to ethical dilemmas in clinical practice, which of the following
statements is correct?

Select one:
a.
Early and empathetic communication can help both prevent and respond to ethical conflict.

b.
They should be avoided by making every effort to address them as early as possible.

c.
The best way to analyze and comment on them is to use ethical principles to highlight the values
involved.

d.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

A hospital executive decides to close his emergency department to expand his private
orthopedic surgery practice in order to make more money for the hospital. Which ethical
principle does this action have the greatest impact on?

Select one:

a.
Freedom

b.
Justice

c.
Autonomy
d.
Non-maleficence

Feedback

Correct answer

The correct answer is: Justice

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding the principle of autonomy, which of the following statements is correct?

Select one:

a.
It must always take precedence over other principles

b.
All patients should be provided with specific information about their diagnosis and treatment.

c.
All patients should be asked what kind of information they want to receive about their diagnosis and
treatment and how they want to be involved in making decisions about their care.

Feedback

Correct answer

The correct answer is: All patients should be asked what kind of information they want to receive about
their diagnosis and treatment and how they want to be involved in making decisions about their care.

Question10
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

Regarding ethical principles in different cultures:

Select one:

a.
Since morals and values are universal, ethical principles are also the same in all cultures.

b.
Ethical practice should never go against the norms of the local culture.

c.
Although culture must always be taken into account, sometimes ethical practice can go against generally
accepted norms.

Feedback

Correct answer

The correct answer is: Although culture should always be taken into account, sometimes ethical practice
can go against generally accepted norms.

Question1
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

7.When transmitting prognostic information, all of the following statements are correct
EXCEPT:

Select one:

a.
It always has a positive impact, regardless of how the information is presented.

b.
Reduces symptoms of anxiety and emotional distress

c.
Improved patient and family satisfaction

d.
It is essential to improve the quality of health care.

Feedback

Correct answer

The correct answer is: It always has a positive impact, regardless of how the information is presented.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Choose the correct statement about forecast conversations:

Select one:

a.
It is not an essential part of good health care.

b.
Should not be performed when the diagnosis is uncertain.

c.
Lack of time and training are obstacles perceived by health professionals.

d.
They should be taught and practiced just like any other medical procedure.
Feedback

Correct answer

The correct answer is: Lack of time and training are obstacles perceived by health professionals.

Question3
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Behaviors that patients and families value when discussing difficult news with health care
professionals include all of the following EXCEPT:

Select one:

a.
The use of empathetic communication

b.
The use of technical and professional terminology

c.
The patient's hopes and fears are addressed.

d.
Dedicating sufficient time to listening to the patient's questions and concerns

Feedback

Correct answer

The correct answer is: The use of technical and professional terminology.

Question4
Correct
Scores 1.00 out of 1.00

Check question
Statement of the question

Which of the following statements is FALSE?

Select one:

a.
One of the most important questions in palliative care is "Tell me more about it."

b.
Simple and complex reflective listening can be useful to gather more information.

c.
Listening and empathy are essential principles of communication.

d.
The information preferences are the same for all patients.

Feedback

Correct answer

The correct answer is: Information preferences are the same for all patients.

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

An important component of palliative care is discussion with patients and their families about
the overall goals of care. For which of the following reasons is this an important task?

Select one:

a.
To help determine at what point disease-modifying treatments cease to be feasible or effective

b.
To prevent the use of interventions that may cause more harm to the patient than benefit
c.
To harmonize the treatment objectives with the values of each individual patient

d.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Prognostic awareness is:

Select one:

a.
The patient's ability to understand his or her prognosis and disease trajectory over time

b.
The physician's ability to understand the prognosis and trajectory of the disease.

c.
Usually concrete and static over time

d.
Something that can easily be encouraged with a single prognostic conversation at an early stage of the
patient's disease.

Feedback

Correct answer

The correct answer is: The patient's ability to understand their prognosis and disease trajectory over
time.
Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding best practices in palliative care communication, which of the following statements is
correct?

Select one:

a.
Empathy can facilitate communication but, since this is something that everyone is born with (and not
something that can be taught), it is not considered a key element of palliative care communication.

b.
Listening is essential. Healthcare professionals should aim not to talk for more than 50% of the time in
order to improve patient and family satisfaction.

c.
Health care professionals should provide prognostic information at the beginning of a conversation to
"set the stage" for discussion.

d.
When providing prognostic information, health care professionals should give specific information in
exactly the same way in all patients to avoid any possible bias.

Feedback

Correct answer

The correct answer is: Listening is essential. Healthcare professionals should aim not to talk for more
than 50% of the time in order to improve patient and family satisfaction.

Question8
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

The use of hope/worry statements promotes:

Select one:

a.
Alignment and strengthening of the patient-healthcare professional relationship.

b.
Complicity with the health care team

c.
Acceptance of the end of life

d.
Avoidance of emotional expression

Feedback

Correct answer

The correct answer is: Alignment and strengthening of the patient-health professional relationship.

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Inappropriate communication can influence:

Select one:

a.
An increased risk of medico-legal claims
b.
A lack of compliance with the therapeutic regimen

c.
A reduced likelihood of achieving the treatment goals that have been established

d.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question10
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Visiting one of his patients who has advanced lung cancer, he explains that the latest CT scan
suggests that the cancer is getting worse. The patient is visibly upset and begins to cry.
Reasonable answers would be all of the following EXCEPT:

Select one:

a.
Sit quietly, allowing the patient time to collect his or her thoughts.

b.
Saying "I can't even imagine how hard it must be to receive this news."

c.
Say "It's okay - please don't worry. We still have other chemotherapy options we can try."

d.
Say "I realize how sad you are about this information. I'm so sorry."

Feedback

Correct answer

The correct answer is: Say "It's okay - please don't worry. We still have other chemotherapy options we
can try."

Question1
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following isnot a classic sign of opioid-induced neurotoxicity?

Select one:

a.
Myoclonus

b.
Hyperalgesia

c.
Confusional state(delirium)

d.
Seizures

e.
Dysphagia

Feedback

Correct answer

The correct answer is: Dysphagia

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

One of his patients has been admitted to the terminal care unit for end-of-life care. His wife
requests prognostic information because her son hopes to be able to travel to be present at
the time of his father's death. You can estimate that this patient probably has a prognosis on
the order of days to perhaps a week. Which of the following is an early sign of end-of-life
transition?

Select one:

a.
Oropharyngeal secretions

b.
Cheyne-Stokes respiration

c.
Absence of pulse in the radial artery

d.
Dysphagia for liquids

e.
Breathing with jaw movement

Feedback

Correct answer

The correct answer is: Dysphagia for liquids.

Question3
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

Your patient has been using more frequent morphine boluses for pain control. You have had
increased swallowing difficulty and you decide to start a continuous infusion to improve
symptom control. You decide to incorporate 50% of the doses used in embolization during the
last 24 hours to the basal administration. Approximately how long will it take for the starting
basal administration to reach the stable equilibrium phase?

Select one:

a.
2 hours

b.
4 hours

c.
8 hours

d.
12 hours

e.
24 hours

Feedback

Correct answer

The correct answer is: 8 hours

Question4
Correct
Scores 1.00 out of 1.00

Check question
Statement of the question

You provide care to a patient who has a prognosis of days or weeks. He is beginning to have
hallucinations. Which of the following etiologies of confusional state(delirium) should you
consider?

Select one:

a.
Constipation

b.
Urinary retention

c.
Infection

d.
Pain

e.
All of the above

f.
None of the above

Feedback

Correct answer

The correct answer is: All of the above

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

You provide care to a dying patient who has an extended family to provide support. The
patient has had secretions in the last few hours of her life and, although you know that they
are probably not causing her any discomfort, the family shows some concern about it. Which
of the following medications is least likely to cause a confusional state(delirium) since it does
not cross the blood-brain barrier?

Select one:

a.
Scopolamine

b.
Glycopyrrolate

c.
Atropine

d.
Hyoscyamine

Feedback

Correct answer

The correct answer is: Glycopyrrolate.

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

All of the following are ordinary components of palliative care provided to patients at the end
of life EXCEPT:

Select one:

a.
Treatment of physical symptoms causing discomfort

b.
Psychosocial support to both the patient and his family

c.
Administration of oxygen and artificial nutrition and hydration until death is confirmed.

d.
Conversation on spiritual concerns

Feedback

Correct answer

The correct answer is: Administration of oxygen and artificial nutrition and hydration until death is
confirmed.

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Regarding terminal confusional state(delirium), which of the following is a correct statement?

Select one:

a.
It is a rare event in patients at the end of life.

b.
It is almost always reversible if the underlying cause is determined.

c.
Usually must be treated with medication as non-pharmacological measures have not been found to be
effective.

d.
It is a sign of poor prognosis and can also cause particular distress to family members.

Feedback

Correct answer

The correct answer is: It is a sign of poor prognosis and may also cause particular distress to family
members.
Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

A family member notices that his loved one has stopped taking anything by mouth, not even
liquids. They ask that a peripheral intravenous catheter be used to administer intravenous
fluids as they are concerned about her becoming thirsty. You suspect this patient has hours or
a few days to live and are concerned that intravenous fluids may cause harm. What is the
empathetic response to the request to administer intravenous fluids?

Select one:

a.
"Most patients do not suffer from thirst. If we can moisten his mouth with wet gauze, I think he'll be
comfortable."

b.
"Intravenous fluids can cause a person to die sooner. Do you intend to hasten his death?"

c.
"Intravenous fluids will do nothing more than flood your lungs and abdomen with fluid. I'm not going to
do that to my patient."

d.
"Fluids are not going to resolve his confusional state or his agitation. He's going to die anyway."

Feedback

Correct answer

The correct answer is: "Most patients are not thirsty. If we can moisten his mouth with wet gauze, I think
he'll be comfortable."

Question9
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

All of the following are common end-of-life symptoms EXCEPT:

Select one:

a.
Decreased diuresis

b.
Confusional state(delirium)

c.
Cheyne-Stokes respiration

d.
Increase in basal temperature

Feedback

Correct answer

The correct answer is: Increase in basal temperature.

Question10
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following isnot applicable in palliative care at the end of life?

Select one:

a.
Better support for caregivers
b.
Higher proportion of hospitalizations

c.
Improvement of symptomatic treatment

d.
Reduction in the average length of hospital stays

e.
Increased satisfaction with the care received

Feedback

Correct answer

The correct answer is: Higher proportion of hospitalizations.

Lñññññññññññññññññññññññññññññññññññññññññññññññññññ

To increase resilience, clinicians caring for critically ill patients should:

Select one:

a.
Working alone to be more efficient

b.
Work only with like-minded people

c.
Seek to collaborate with colleagues with whom they can share difficult experiences and have free time.

d.
Work as hard as possible to get used to stress

Feedback

Correct answer
The correct answer is: Try to collaborate with colleagues with whom they can share difficult experiences
and have free time.

Question2
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

A 48-year-old nurse has been working in an oncology hospital for the past 10 years. He has not
taken a vacation in the last two years. Lately he has had fatigue, inefficiency at work, and lack
of interest in his patients' stories, and he is thinking of quitting his job. Which of the following
best describes what you are experiencing?

Select one:

a.
Antisocial personality disorder

b.
Resilience

c.
Exhaustion(burnout)

d.
Dementia

Feedback

Correct answer

The correct answer is:Burnout.

Question3
Correct
Scores 1.00 out of 1.00

Check question
Statement of the question

The warning signs of caregiverburnout are all of the following EXCEPT.

Select one:

a.
Balancing workload and productivity requirements

b.
Reduced overall life satisfaction

c.
Persistent anxiety, anger or feelings of guilt

d.
Self-perpetuating fatigue

Feedback

Correct answer

The correct answer is: Balance of workload and productivity requirements.

Question4
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Work factors that can increase resilience are:

Select one:

a.
Promotion of justice

b.
Structuring of rewards

c.
Recognition of values

d.
All of the above

Feedback

Correct answer

The correct answer is: All of the above

Question5
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

One of the following is not a symptom ofburnout:

Select one:

a.
Sleep problems

b.
Mood fluctuations

c.
Involvement

d.
Resentment

Feedback

Correct answer

The correct answer is: Involvement

Question6
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

All of the following are important ways to improve individual resilience by building on one's
own competencies EXCEPT:

Select one:

a.
Work on the basis of personal strengths

b.
Focus on one's weaknesses and work hard to overcome them.

c.
Search for meaning and purpose in one's work

d.
Identifying healthy boundaries with patients and peers

Feedback

Correct answer

The correct answer is: Focus on one's weaknesses and work hard to overcome them.

Question7
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

Which of the following statements is FALSE?

Select one:
a.
Compassion fatigue is a physical, emotional and spiritual exhaustion associated with caring for patients
with significant distress.

b.
The healing process is an event that can usually be completed within a short period of time.

c.
Participation in continuing education activities is an individual strategy that can increase resilience.

d.
Community building is the perception of a positive connection with others in the workplace

Feedback

Correct answer

The correct answer is: The healing process is an event that can usually be completed in a short period of
time.

Question8
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

All of the following are ways clinicians increase their resilience EXCEPT:

Select one:

a.
Schedule vacation time on a regular basis

b.
Learning to ask for help without feeling guilty

c.
Improve their own capabilities to try to work beyond their personal limits.
d.
Avoid comparing your capabilities with those of others at work.

Feedback

Correct answer

The correct answer is: Improve your own capabilities to try to work beyond your personal limits.

Question9
Correct
Scores 1.00 out of 1.00

Check question

Statement of the question

All of the following are risk factors forburnout EXCEPT:

Select one:

a.
Inadequacy of the professional career path

b.
Increased administrative responsibilities

c.
Flexibility

d.
Excessive workload

Feedback

Correct answer

The correct answer is: Flexibility

Question10
Correct
Scores 1.00 out of 1.00
 Check question

Statement of the question

To minimize the impact of stress and increase resiliency, clinicians caring for patients with life-
threatening illnesses

Select one:

a.
They should not talk to anyone about their professional losses

b.
They should try to have a home environment that allows them to rest and recuperate.

c.
They should avoid talking to patients or family members.

d.
They should never think of a patient who has died.

Feedback

Correct answer

The correct answer is: They should try to have a home environment that allows them to rest and
recuperate.