Virtual Mentor. January 2003, Volume 5, Number 1.
Test Questions: End-of-Life Care: Do No Harm
Multiple choice questions may have one or more than one right answer.
1. Which of the following is a primary goal of prognostication in cases of terminal illness?
a. Including patients in treatment planning.
2. Which of the following describe necessary characteristics of prognosis communication?
a. Direct and brief.
3. Which of the following in not permitted by the ethical standards of the medical profession as expressed in the AMA's Code of Medical Ethics?
a. Removing from the ventilator an unconscious patient with no respiratory capability who, while conscious, expressed a desire not to be ventilator-dependent.
4. The physician-author of Clinical Case 2 (Ventilator Withdrawal of Patients with "Zero Capability" for Respiratory Function) believes that reactive opioid dosing during terminal ventilator withdrawal of patients who have zero respiratory capability but central respiratory drive in tact compromises patient comfort to the point where the principles of beneficence and non-maleficence are threatened.
5. Two patients are being withdrawn from the ventilator. While conscious, both expressed the wish to be disconnected from the ventilator when they could no longer stay alive without it. Both are expected to die as a result of ventilator withdrawal. Both have central respiratory drive in tact. Patient P has zero respiratory capability; patient Q has some respiratory capability. The author of Clinical Case 2 argues that:
a. Both patients P and Q should be given preemptive and definitive opioid and benzodiazepine doses to preclude the possibility of air hunger.
6. Which of the following accurately describes what occurs when the parents of a pediatric patient disagree with physicians about whether to treat the child's underlying disease?
a. Parents' interpretation of the patient's best interests always overrides medical judgment.
7. It is ethically acceptable for a physician who is formulating end-of-life treatment plans to consider which of the following?
8. Which of the following may result from failure to communicate realistic prognoses to patients?
a. Greater sense of patient autonomy and control.
9. In which of the following circumstances is it not acceptable to postpone or prolong communicating a terminal prognosis?
a. If the patient asks to wait until after his son's wedding week after next.
10. Mr. K has been taking methadone, 60 mg by mouth every 6 hours, to control pain from metastatic cancer. He is now admitted with radiation-induced esophagitis, and your attending ask that you place him on a constant infusion of intravenous morphine. Without adjusting for cross tolerance, what hourly rate will you choose to control Mr. K's pain?
a. 1 mg/h
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