Buy Palliative Care and End of Life

Buy Palliative Care and End of Life
Buy Palliative Care and End of Life
1. A 61-year-old male is admitted to the intensive care unit (ICU) intubated after an out-of-hospital
cardiac arrest due to myocardial infarction complicated by anoxic brain injury. He has a history
of severe chronic obstructive pulmonary disease (COPD) with home oxygen, poorly controlled
insulin-dependent type II diabetes, chronic kidney disease, and severe peripheral vascular
disease status post left above-the-knee amputation. The patient was assessed to be too high-risk
for percutaneous coronary interventions, and two cardiac surgeons have deemed the patient a
poor surgical candidate. Over the past 24 hours, the patient has remained on multiple high-dose
vasopressors, has become anuric, his creatinine has tripled, and his potassium is 7.0 mEq/dL.
The patient has not filled out an advance directive or assigned a healthcare proxy, and his next
of kin includes his three children. After multiple family meetings, the patient’s children continue
to request renal replacement therapy despite concerns from the ICU team about its medical
appropriateness. Which of the following is NOT a recommended step to conflict resolution
based on the most recent multispecialty consensus statement regarding potentially inappropriate
medical care in the ICU?
A. Obtain a second medical opinion
B. Provide review by an interdisciplinary hospital committee
C. Offer legal counsel to surrogates
D. Offer surrogates the opportunity for transfer to an alternate institution
E. Enlist expert consultation to aid in achieving a negotiated agreement
2. The available evidence suggests that the impact of ICU-based palliative care includes all the
following EXCEPT:
A. Decrease ICU and hospital length of stay
B. Decrease healthcare cost
C. Improve communication with patient
D. Increase in-hospital mortality
3. All the following have been shown to significantly reduce the rate of catheter-related
bloodstream infections (CR-BSIs) occurring in the ICU EXCEPT:
A. Handwashing
B. Use of full-barrier precautions
C. Cleaning the skin with chlorhexidine
D. Avoiding the femoral site for cannulation
E. Performing a time-out before line insertion
4. What is the 1-year mortality risk in a critically ill 67-year-old patient with platelets of
100 × 10
9
Buy Palliative Care and End of Life
Lrequiring hemodialysis and mechanical ventilation on hospital day 21?
A. 10% to 20%
B. 30% to 40%
C. 40% to 50%
D. 60% to 70%
E. >70%
5. Symptoms of postintensive care syndrome (PICS) include all of the following except:
A. Cognitive dysfunction
B. Psychiatric disturbances
C. Metabolic syndrome
D. Musculoskeletal weakness
6. A 64-year-old male with no known prior medical history was admitted 5 days ago with a large
subarachnoid hemorrhage from a suspected ruptured cerebral aneurysm. His current vitals are
blood pressure (BP) 105/70 mm Hg, heart rate 84 beats per minute, respiratory rate 16/min on
volume control ventilation, and temperature 98.8°F. Laboratory data are all within normal
limits. He has not received any central nervous system depressants or paralytics but makes no
respiratory effort after 8 minutes of apnea. He is noted to have an intermittent bilateral finger
tremor, though not in response to stimuli such as pain. All brainstem reflexes are absent. Does
this patient meet the criteria for brain death based on the most recent recommendations by the
Society of Critical Care Medicine?
A. Yes
B. No
7. All of the following conditions in a suspected organ donor are contraindications to organ
donation EXCEPT:
A. Bacteremia on appropriate antibiotics
B. Grade II central nervous system tumor
C. Hepatitis C virus (HCV) seropositive
D. Human immunodeficiency virus (HIV) seronegative but meets the high-risk behavioral criteria
for HIV infection
E. All of the above
F. None the above
8. In patients who are being considered for organ donation after cardiac death (DCD), all of the
following are considered part of the United Network for Organ Sharing (UNOS) criteria for
prediction of death within 60 minutes of withdrawal of life-sustaining treatment (LST),
EXCEPT:
A. Apnea
B. Respiratory rate 30 breaths/min
C. ≥3 vasopressors to maintain a mean arterial pressure (MAP) >65 mm Hg
D. Fio 2 ≥0.5 and Sao 2 ≤92%
E. Norepinephrine or phenylephrine ≥0.2 μg/kg/min
9. True or false: Withholding LST is permissible, but once started, it must be continued.
A. True
B. False
10. Match the following terms with their definitions:
Terms Definitions
a Living will 1 Medical orders
addressing a
range of topics
likely to be
relevant to the
care of a patient
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