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ABA Palliative Care study materials
ABA Palliative Care study resources

ABA Palliative Care practice questions

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First 50 of 199 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

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Question 1Hospice and Palliative Medicine (domain content not enumerated in source)

Which opioid is generally preferred for the initiation of analgesia in a patient with advanced chronic kidney disease because it has the least accumulation of active metabolites?

  1. Codeine
  2. Fentanyl Correct answer.
  3. Morphine
  4. Meperidine

Explanation

Fentanyl is hepatically metabolized and has inactive metabolites, so it does not accumulate in renal failure. Morphine and codeine both produce active metabolites cleared by the kidney, and meperidine accumulates normeperidine, which can cause seizures.

Question 2Hospice and Palliative Medicine (domain content not enumerated in source)

Which agent is the standard first-line treatment for opioid-induced constipation in a patient receiving palliative care?

  1. An opioid antagonist given orally without bowel restriction
  2. A bulk-forming agent such as psyllium
  3. An anticholinergic such as dicyclomine
  4. A stimulant laxative such as senna Correct answer.

Explanation

Stimulant laxatives are first-line prophylaxis and treatment for opioid-induced constipation because opioids slow motility and increase absorption. Bulk-forming agents require adequate fluid and motility and can worsen obstruction.

Question 3Hospice and Palliative Medicine (domain content not enumerated in source)

A dying patient with terminal secretions has noisy breathing. Which medication class is most commonly used to reduce respiratory secretions?

  1. Loop diuretics such as furosemide
  2. Anticholinergics such as glycopyrrolate Correct answer.
  3. Expectorants such as guaifenesin
  4. Mucolytics such as acetylcysteine

Explanation

Anticholinergic agents reduce salivary and bronchial secretions and are the standard pharmacologic approach to death rattle. They do not remove secretions already present, so repositioning and gentle suctioning complement them.

Question 4Hospice and Palliative Medicine (domain content not enumerated in source)

Which finding is most consistent with a prognosis of days to hours in a dying patient?

  1. Mottling of the extremities with cool skin Correct answer.
  2. New interest in eating and conversation
  3. Stable oral intake with normal urine output
  4. Improved alertness and orientation

Explanation

Peripheral mottling, cool extremities, and reduced urine output reflect declining perfusion and are classic signs of imminent death. Improving intake or alertness suggests stability rather than active dying.

Question 5Hospice and Palliative Medicine (domain content not enumerated in source)

Which statement best describes the principle of double effect as applied to palliative sedation for refractory suffering?

  1. A foreseen harmful outcome may be accepted if the intended act is good and the harm is not the means to relief Correct answer.
  2. Any treatment that shortens life is prohibited regardless of intent
  3. Sedation is permissible only when the patient has decisional capacity
  4. The principle applies only to opioid dosing, not to sedatives

Explanation

Double effect permits an act with a good intended effect (relief of suffering) even when a foreseeable bad effect (hastened death) is not intended or used as the means. The proportionality and intention conditions distinguish it from euthanasia.

Question 6Hospice and Palliative Medicine (domain content not enumerated in source)

Which route is generally preferred for administering opioids to a dying patient who can no longer swallow?

  1. Oral immediate-release tablets
  2. Subcutaneous infusion Correct answer.
  3. Intramuscular bolus injections
  4. Rectal suppositories as the only option

Explanation

Subcutaneous infusion provides steady absorption and is preferred when the oral route is unavailable and intravenous access is not needed. Intramuscular injections are painful and unreliable in cachectic patients.

Question 7Hospice and Palliative Medicine (domain content not enumerated in source)

Which drug is used as an adjuvant analgesic specifically for neuropathic pain in palliative care?

  1. Ondansetron
  2. Gabapentin Correct answer.
  3. Ibuprofen
  4. Acetaminophen

Explanation

Gabapentin is an anticonvulsant adjuvant effective for neuropathic pain. Acetaminophen and NSAIDs treat nociceptive pain, and ondansetron is an antiemetic.

Question 8Hospice and Palliative Medicine (domain content not enumerated in source)

Which statement best captures the goal of advance care planning in serious illness?

  1. Transferring all decisions permanently to the physician
  2. Guaranteeing that cardiopulmonary resuscitation will be attempted
  3. Completing paperwork only after the patient loses capacity
  4. Aligning future care with the patient's values and preferences through discussion and documentation Correct answer.

Explanation

Advance care planning is an ongoing process of clarifying values and goals and documenting them so future care can align with them. It is not a one-time form or a transfer of authority to clinicians.

Question 9Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced cancer has severe pain on a stable long-acting opioid regimen and is experiencing end-of-life pain crisis. Which is the most appropriate approach to breakthrough pain?

  1. Switch immediately to a different opioid class
  2. Halve the long-acting opioid dose to avoid toxicity
  3. Add a benzodiazepine as the primary analgesic
  4. Give a short-acting opioid dose proportional to the total daily dose Correct answer.

Explanation

Breakthrough pain is managed with an immediate-release opioid dosed as a fraction (often about 10–20%) of the total daily opioid requirement. Reducing the baseline or substituting sedatives does not treat the pain.

Question 10Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with severe COPD and a life expectancy of months asks about dyspnea relief. Which intervention has the best evidence for relieving refractory dyspnea in this setting?

  1. Oral theophylline
  2. Low-dose systemic opioids Correct answer.
  3. High-dose inhaled corticosteroids
  4. Supplemental oxygen regardless of saturation

Explanation

Low-dose opioids are effective for refractory dyspnea in advanced disease, including COPD. Oxygen benefits only patients with hypoxemia, and theophylline has a narrow therapeutic index without a clear palliative benefit.

Question 11Hospice and Palliative Medicine (domain content not enumerated in source)

A patient on high-dose opioids develops myoclonus and hyperalgesia. Which is the most appropriate next step?

  1. Start a benzodiazepine as the primary treatment
  2. Add a stimulant laxative
  3. Increase the opioid dose to control the symptoms
  4. Reduce the opioid dose and consider opioid rotation Correct answer.

Explanation

Myoclonus and hyperalgesia suggest opioid-induced neurotoxicity from accumulated metabolites. Reducing the dose and rotating to a different opioid, often one with fewer active metabolites, is appropriate.

Question 12Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness reports nausea that is worse after meals and associated with early satiety. Which agent is most appropriate?

  1. Metoclopramide Correct answer.
  2. Scopolamine
  3. Ondansetron
  4. Dexamethasone

Explanation

Postprandial nausea with early satiety suggests delayed gastric emptying or gastroparesis, for which a prokinetic such as metoclopramide is appropriate. Scopolamine treats vestibular nausea and would slow emptying further.

Question 13Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with a malignant bowel obstruction is not a surgical candidate. Which combination best supports comfort?

  1. Octreotide with dexamethasone plus an antiemetic Correct answer.
  2. High-dose laxatives plus metoclopramide
  3. Oral fluid challenge plus a bulk-forming agent
  4. Erythromycin plus a stimulant laxative

Explanation

Octreotide reduces gastrointestinal secretions and dexamethasone reduces peritumoral edema, both relieving obstruction symptoms. Antiemetics control associated nausea and vomiting.

Question 14Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced dementia has stopped eating and drinking. The family asks about artificial nutrition. Which response is most appropriate?

  1. State that stopping oral intake always indicates untreated pain
  2. Recommend intravenous fluids to prolong life at all costs
  3. Recommend a feeding tube to prevent aspiration
  4. Explain that artificial nutrition does not improve comfort or survival in advanced dementia and offer mouth care Correct answer.

Explanation

In advanced dementia, tube feeding has not been shown to improve survival, comfort, or aspiration risk and may cause harm. Comfort-focused oral care and family support are preferred.

Question 15Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with severe cancer pain on morphine develops acute confusion and myoclonic jerks. Which action is most appropriate?

  1. Rotate to an equianalgesic dose of a different opioid such as fentanyl Correct answer.
  2. Stop all analgesia
  3. Add haloperidol and continue the same morphine dose
  4. Double the morphine dose

Explanation

Neuroexcitatory effects suggest opioid metabolite accumulation; rotating to an opioid with inactive metabolites while maintaining analgesia is appropriate. Simply adding an antipsychotic or escalating the dose does not address the toxicity.

Question 16Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with end-stage heart failure has dyspnea and edema despite optimal heart failure therapy. Which approach best supports comfort?

  1. Add low-dose opioids and consider diuretics for volume overload Correct answer.
  2. Start high-dose beta-blockers to improve symptoms
  3. Restrict all fluids and discontinue diuretics
  4. Begin routine inotropic infusions indefinitely

Explanation

In advanced heart failure, low-dose opioids relieve dyspnea and diuretics manage congestion when appropriate. Routine indefinite inotropes are not standard comfort care and carry risks.

Question 17Hospice and Palliative Medicine (domain content not enumerated in source)

A patient reports severe pain with a neuropathic quality after spinal cord injury. Which combination is most appropriate?

  1. Acetaminophen alone
  2. A benzodiazepine alone
  3. An opioid plus gabapentin Correct answer.
  4. An NSAID alone

Explanation

Neuropathic pain often requires an opioid combined with an adjuvant such as gabapentin. Simple analgesics alone are usually insufficient for neuropathic pain.

Question 18Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with terminal illness and severe agitation and delirium is distressed despite nonpharmacologic measures. Which approach is most appropriate?

  1. Withhold all medication to avoid sedation
  2. Use a neuroleptic such as haloperidol while addressing reversible causes Correct answer.
  3. Start a benzodiazepine as first-line for hyperactive delirium
  4. Use physical restraints as the primary intervention

Explanation

Haloperidol is commonly used for distressing delirium in palliative care while reversible causes are evaluated. Benzodiazepines can worsen delirium and are not first-line except in specific contexts such as alcohol withdrawal.

Question 19Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced cancer and a prognosis of weeks has severe dyspnea and is anxious. Which medication is most appropriate for acute relief?

  1. A tricyclic antidepressant
  2. A long-term bronchodilator
  3. A short-acting opioid such as morphine Correct answer.
  4. A stimulant such as methylphenidate

Explanation

Short-acting opioids are effective for rapid relief of dyspnea in advanced illness. Bronchodilators, stimulants, and antidepressants do not provide acute relief.

Question 20Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness reports nausea and vomiting with a vestibular component (worse with head movement). Which agent is most appropriate?

  1. Ondansetron
  2. Dexamethasone
  3. Metoclopramide
  4. Scopolamine Correct answer.

Explanation

Vestibular nausea responds to anticholinergic or antihistaminergic agents such as scopolamine. Prokinetics and serotonin antagonists target different mechanisms.

Question 21Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with end-stage renal disease on dialysis has pain requiring an opioid. Which agent is most appropriate?

  1. Fentanyl Correct answer.
  2. Meperidine
  3. Codeine
  4. Morphine

Explanation

Fentanyl is preferred in renal failure because its metabolites are inactive and do not accumulate. Morphine, codeine, and meperidine all have active or toxic renally cleared metabolites.

Question 22Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness and severe pain has a total daily oral morphine requirement of 60 mg. What is the approximate appropriate dose for a breakthrough pain episode?

  1. 1 mg of immediate-release morphine
  2. 120 mg of immediate-release morphine
  3. 60 mg of immediate-release morphine
  4. 10 mg of immediate-release morphine Correct answer.

Explanation

Breakthrough dosing is typically about 10–20% of the total daily opioid requirement. For a 60 mg daily requirement, roughly 6–12 mg is appropriate, making 10 mg the best choice.

Question 23Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with severe cancer pain on oral morphine 30 mg every 4 hours is to be converted to a transdermal fentanyl patch. Which consideration is most important?

  1. Calculate an equianalgesic dose and account for the delayed onset of transdermal absorption Correct answer.
  2. Use the patch for acute uncontrolled pain
  3. Apply the patch and stop the oral opioid immediately
  4. Double the patch dose if pain persists within an hour

Explanation

Conversion requires equianalgesic calculation and recognition that transdermal fentanyl has a slow onset and long duration, so the oral opioid is continued during transition. Patches are inappropriate for acute pain titration.

Question 24Hospice and Palliative Medicine (domain content not enumerated in source)

A dying patient has a respiratory rate of 8/min and is receiving high-dose opioids for pain. Which action is most appropriate?

  1. Assess for reversible causes and consider reducing the opioid dose while maintaining comfort Correct answer.
  2. Administer naloxone to fully reverse the opioid
  3. Continue the current dose unchanged and monitor
  4. Increase the opioid dose to prevent pain

Explanation

In a dying patient, the goal is comfort; if respiratory depression is contributing to distress, the dose may be adjusted while treating reversible contributors. Full reversal with naloxone can precipitate severe pain and withdrawal.

Question 25Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has severe pain and is being transitioned from intravenous to oral hydromorphone. Which principle is most important?

  1. Apply an equianalgesic conversion and reassess after the switch Correct answer.
  2. Reduce the dose by half regardless of route
  3. Switch routes without considering bioavailability
  4. Use the same milligram dose for both routes

Explanation

Equianalgesic conversion accounts for differences in route bioavailability and potency, and reassessment after conversion is essential. Using identical doses across routes risks under- or overdosing.

Question 26Hospice and Palliative Medicine (domain content not enumerated in source)

Which principle underlies the ethical justification for proportional sedation to unconsciousness in a dying patient with refractory symptoms?

  1. The standard of substituted judgment
  2. The rule of informed consent
  3. The principle of distributive justice
  4. The doctrine of double effect Correct answer.

Explanation

The doctrine of double effect permits an act with a good intended effect (relief of refractory suffering) even if a foreseen but unintended effect (hastened death) may occur, provided the intent and proportionality conditions are met. It is the classic ethical framework invoked for palliative sedation.

Question 27Hospice and Palliative Medicine (domain content not enumerated in source)

Which finding is most consistent with a diagnosis of delirium rather than depression in an acutely ill palliative care patient?

  1. Consistent anhedonia with intact attention
  2. Acute onset with fluctuating attention and awareness Correct answer.
  3. Stable, persistent psychomotor slowing without fluctuation
  4. Gradual onset over several weeks of low mood

Explanation

Delirium is characterized by acute onset, fluctuating course, and impaired attention/awareness. Depression typically has a more gradual onset with preserved attention and a stable course.

Question 28Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has a prognosis of days and is actively dying with audible gurgling from secretions. Which intervention is most appropriate?

  1. Anticholinergic medication such as glycopyrrolate Correct answer.
  2. Suctioning every 15 minutes
  3. Aggressive chest physiotherapy
  4. Encouraging oral fluids to thin secretions

Explanation

Death rattle from pooled oropharyngeal secretions is managed with anticholinergics (e.g., glycopyrrolate, scopolamine) to reduce secretion production. Deep suctioning and fluid loading are generally ineffective or burdensome in the actively dying.

Question 29Hospice and Palliative Medicine (domain content not enumerated in source)

Which assessment tool is a validated single-item screen for dyspnea intensity in palliative care?

  1. The Braden Scale
  2. The Glasgow Coma Scale
  3. The Mini-Mental State Examination
  4. The Edmonton Symptom Assessment System dyspnea numeric rating scale Correct answer.

Explanation

The ESAS includes a validated 0-10 numeric rating scale for dyspnea and is widely used in palliative symptom assessment. The other instruments measure consciousness, pressure injury risk, and cognition, respectively.

Question 30Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced cancer reports constipation despite adequate hydration and activity. Which initial laxative strategy is most appropriate when starting an opioid?

  1. No prophylaxis until constipation occurs
  2. A stimulant laxative such as senna, with a stool softener if needed Correct answer.
  3. A bulk-forming fiber supplement alone
  4. An osmotic laxative alone as monotherapy

Explanation

Opioid-induced constipation is best prevented with a stimulant laxative, often combined with a stool softener. Prophylaxis should begin when opioids are started rather than waiting for symptoms.

Question 31Hospice and Palliative Medicine (domain content not enumerated in source)

Which intervention best addresses existential or spiritual suffering in a patient with advanced illness who reports feeling that life is meaningless?

  1. Starting an SSRI immediately
  2. Dignity-conserving or meaning-centered counseling with chaplaincy involvement Correct answer.
  3. Increasing the opioid dose
  4. Recommending against further discussion of these feelings

Explanation

Existential distress is addressed through meaning-centered or dignity-conserving approaches, often with chaplaincy and psychosocial support. Pharmacologic escalation is not the primary treatment for existential suffering.

Question 32Hospice and Palliative Medicine (domain content not enumerated in source)

Which statement accurately describes the role of palliative care consultation alongside disease-directed therapy?

  1. It is limited to inpatient settings
  2. It can be provided concurrently with curative or life-prolonging treatment Correct answer.
  3. It requires the patient to forgo life-prolonging treatment
  4. It is appropriate only after disease-directed options are exhausted

Explanation

Palliative care is appropriate at any stage of serious illness and can be delivered alongside curative or life-prolonging therapy. It is not restricted to end-of-life care or inpatient settings.

Question 33Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has a large malignant wound with malodor and exudate. Which measure most directly addresses the odor?

  1. Daily hydrogen peroxide irrigation
  2. Oral iron supplementation
  3. Occlusive film dressing without change
  4. Topical metronidazole Correct answer.

Explanation

Malignant wound odor is often due to anaerobic infection, and topical metronidazole directly targets this. Gentle cleansing and appropriate absorbent dressings complement this approach.

Question 34Hospice and Palliative Medicine (domain content not enumerated in source)

Which symptom cluster is most characteristic of the last days of life in a patient dying of advanced cancer?

  1. Acute severe abdominal pain with guarding
  2. Decreasing oral intake, increasing somnolence, and cool extremities Correct answer.
  3. Sudden return of appetite and increased urine output
  4. New-onset fever with rigors and productive cough

Explanation

The dying phase is typically marked by reduced intake, increasing somnolence, mottling, and cool extremities as circulation diminishes. Families often need anticipatory guidance about these expected changes.

Question 35Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with ALS has dyspnea and a weak cough with retained secretions. Which nonpharmacologic intervention is most appropriate to add?

  1. Deep sedating doses of benzodiazepines
  2. Fluid restriction to dryness
  3. Noninvasive ventilation and cough-assist techniques Correct answer.
  4. Routine broad-spectrum antibiotics

Explanation

In neuromuscular disease, noninvasive ventilation and cough-assist devices improve ventilation and secretion clearance. These support breathing without the burdens of deep sedation.

Question 36Hospice and Palliative Medicine (domain content not enumerated in source)

Which agent is most appropriate for the management of malignant bowel obstruction symptoms when surgery is not feasible, targeting colicky pain and nausea?

  1. High-dose oral laxatives
  2. A prokinetic agent such as metoclopramide
  3. Octreotide with an anticholinergic and an antiemetic Correct answer.
  4. A bulk-forming fiber supplement

Explanation

In inoperable malignant bowel obstruction, octreotide reduces secretions and anticholinergics relieve colic, while antiemetics control nausea. Prokinetics and laxatives are generally avoided because of the obstruction.

Question 37Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has moderate-to-severe pain and is opioid-naive. Which starting approach is safest?

  1. Start a low dose of a short-acting opioid and titrate to effect Correct answer.
  2. Start a high-dose long-acting opioid immediately
  3. Start transdermal fentanyl as first-line therapy
  4. Use meperidine as the preferred agent

Explanation

Opioid-naive patients should begin with low-dose short-acting opioids titrated to response to avoid oversedation and respiratory depression. Long-acting and transdermal agents are not first-line in the opioid-naive.

Question 38Hospice and Palliative Medicine (domain content not enumerated in source)

Which statement about the use of corticosteroids in advanced cancer is most accurate?

  1. They can improve appetite and fatigue but carry risks of hyperglycemia and infection Correct answer.
  2. They are first-line for neuropathic pain
  3. They reliably reverse all cancer-related fatigue permanently
  4. They have no role in malignant bowel obstruction

Explanation

Corticosteroids can transiently improve appetite, fatigue, and pain from mass effect, but adverse effects include hyperglycemia, infection, and myopathy. Their benefits are often temporary.

Question 39Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness reports severe fatigue. Which intervention has the best evidence for cancer-related fatigue in palliative care?

  1. Exercise and energy conservation combined with treatment of reversible contributors Correct answer.
  2. Bed rest as the primary strategy
  3. Routine high-dose stimulants for all patients
  4. Routine blood transfusions regardless of hemoglobin

Explanation

Evidence supports exercise and energy conservation plus correction of reversible causes such as anemia, depression, or poor sleep. Routine stimulants and bed rest are not broadly supported.

Question 40Hospice and Palliative Medicine (domain content not enumerated in source)

Which statement best describes the concept of total pain in palliative care?

  1. Pain is best measured only by vital signs
  2. Pain intensity is determined only by tissue damage
  3. Pain encompasses physical, psychological, social, and spiritual dimensions Correct answer.
  4. Pain is purely a nociceptive phenomenon

Explanation

Total pain recognizes that suffering includes physical, emotional, social, and spiritual components, all of which must be assessed. Addressing only nociception may leave suffering unrelieved.

Question 41Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has severe nausea and is unable to take oral medications. Which route is most appropriate for antiemetic administration?

  1. Topical application to intact skin
  2. Subcutaneous administration Correct answer.
  3. Rectal administration only
  4. Intramuscular administration

Explanation

Subcutaneous delivery is reliable, minimally invasive, and appropriate for patients unable to swallow. It is a mainstay for symptom control in palliative care.

Question 42Hospice and Palliative Medicine (domain content not enumerated in source)

Which finding suggests that a patient's dyspnea is partly driven by anxiety rather than hypoxemia alone?

  1. Cyanosis with severe hypoxemia
  2. Dyspnea out of proportion to oxygen saturation and worsened by distress Correct answer.
  3. Dyspnea only on exertion with normal resting saturation
  4. Dyspnea that resolves completely with supplemental oxygen

Explanation

Dyspnea disproportionate to measured oxygenation and responsive to calming interventions suggests an anxiety component. Treatment then includes anxiolytics and nonpharmacologic measures alongside oxygen.

Question 43Hospice and Palliative Medicine (domain content not enumerated in source)

A family asks whether morphine will hasten death when used for pain at the end of life. Which response is most accurate?

  1. When titrated to symptoms, opioids are not shown to shorten survival and relieve suffering Correct answer.
  2. Morphine always shortens life and should be avoided
  3. Opioids should be given only if the patient is intubated
  4. Opioids should be withheld until pain is unbearable

Explanation

Evidence does not support the claim that appropriately titrated opioids shorten survival; they relieve suffering. Withholding opioids until pain is unbearable causes avoidable distress.

Question 44Hospice and Palliative Medicine (domain content not enumerated in source)

Which advance directive document specifically records a patient's preferences for treatments such as ventilation or dialysis if they lose decision-making capacity?

  1. A physician order for life-sustaining treatment signed by the family
  2. A do-not-resuscitate order alone
  3. A durable power of attorney for finances
  4. A living will Correct answer.

Explanation

A living will documents treatment preferences in advance for situations of incapacity. It differs from a POLST, which is a clinician order, and from financial powers of attorney.

Question 45Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has a prognosis of weeks and reports severe anxiety and insomnia. Which medication class is most appropriate for short-term symptom control?

  1. Antipsychotics as first-line for anxiety
  2. Tricyclic antidepressants as first-line
  3. Beta-blockers
  4. Benzodiazepines such as lorazepam Correct answer.

Explanation

Benzodiazepines provide rapid short-term relief of anxiety and insomnia in patients with limited prognosis. Antidepressants have a delayed onset and are not first-line for acute symptom control.

Question 46Hospice and Palliative Medicine (domain content not enumerated in source)

Which statement best describes the appropriate use of artificial hydration in a dying patient with advanced illness?

  1. It is always mandatory regardless of goals of care
  2. It reliably improves comfort and survival in the dying phase
  3. It should be given only intravenously at high volumes
  4. It is optional and should be guided by patient goals and burdens of treatment Correct answer.

Explanation

Artificial hydration in the dying phase is a preference-sensitive decision guided by goals of care and assessment of burdens and benefits. It is not universally required.

Question 47Hospice and Palliative Medicine (domain content not enumerated in source)

Which symptom is most commonly undertreated in patients with advanced heart failure receiving palliative care?

  1. Dyspnea Correct answer.
  2. Hematuria
  3. Diarrhea
  4. Pruritus

Explanation

Dyspnea is a prominent and often undertreated symptom in advanced heart failure. Its management includes diuretics, oxygen when indicated, and opioids for refractory breathlessness.

Question 48Hospice and Palliative Medicine (domain content not enumerated in source)

A patient with advanced illness has severe pain and is being started on an opioid. Which co-prescribed medication is most appropriate to prevent nausea?

  1. A stimulant laxative
  2. A dopamine antagonist antiemetic such as metoclopramide Correct answer.
  3. A benzodiazepine
  4. An NSAID

Explanation

Opioid-induced nausea is common early in therapy and is managed with antiemetics such as dopamine antagonists. Laxatives address constipation, not nausea.

Question 49Hospice and Palliative Medicine (domain content not enumerated in source)

Which finding in a patient receiving opioids should prompt concern for opioid-induced neurotoxicity?

  1. Myoclonus with hyperalgesia and agitation Correct answer.
  2. Increased urine output
  3. Bradycardia with hypotension
  4. Improved analgesia with stable dosing

Explanation

Myoclonus, hyperalgesia, and agitation suggest accumulation of neurotoxic metabolites. Management includes dose reduction, hydration, and rotation to another opioid.

Question 50Hospice and Palliative Medicine (domain content not enumerated in source)

Which intervention is most appropriate for a patient with advanced illness and a pressure injury who is at the end of life and reports pain with repositioning?

  1. Premedicate before repositioning and use pressure-redistributing surfaces Correct answer.
  2. Reposition every hour regardless of distress
  3. Apply tight constrictive bandages
  4. Withhold all analgesia to avoid sedation

Explanation

Premedication before repositioning and pressure-redistributing surfaces balance comfort with skin protection. Forced frequent repositioning can cause unnecessary suffering at the end of life.