Palliative/Hospice Care
Match the symptom with the appropriate management strategy.
Treatments: haloperidol, saliva substitutes, atropine ophthalmic solution, morphine
a. Oral secretions
b. Dry mouth
c. Air hunger
d. Nausea
a. Oral secretions: atropine ophthalmic solution
b. Dry mouth: saliva substitutes
c. Air hunger: morphine
d. Nausea: haloperidol
Which of the following is the red blood cell (RBC) index/name that designates the average size/volume of RBCs?
a. MCHC
b. MCV
c. HgB
d. HCT
a. MCHC
*b. MCV
c. HgB
d. HCT
What is the purpose of the use of intermittent pneumatic compression devices in the critical care environment?
a. A form of non-pharmacologic venous thromboembolism (VTE) prophylaxis
b. Calculates the goal calories based on risk and illness
c. Acts as an objective way to associate pharmacist workload with patient outcomes
d. Elevates the head and thorax for mechanically ventilated patients
*a. A form of non-pharmacologic venous thromboembolism (VTE) prophylaxis
b. Calculates the goal calories based on risk and illness
c. Acts as an objective way to associate pharmacist workload with patient outcomes
d. Elevates the head and thorax for mechanically ventilated patients
Which of the following insulin formulations is the preferred option in diabetic ketoacidosis (DKA)?
a. SQ regular insulin
b. IV regular insulin
c. SQ rapid-acting insulin
d. IV rapid-acting insulin
a. SQ regular insulin
*b. IV regular insulin
c. SQ rapid-acting insulin
d. IV rapid-acting insulin
What would be the best pain option for a patient who is mechanically ventilated in the ICU, post-abdominal surgery, with concerns for acute kidney injury?
a. IV acetaminophen
b. PO gabapentin
c. IV morphine
d. IV ketorolac
*a. IV acetaminophen
b. PO gabapentin
c. IV morphine
d. IV ketorolac
Which of the following medications is classified as an inotrope?
a. Epinephrine
b. Angiotensin II
c. Vasopressin
d. Dobutamine
a. Epinephrine
b. Angiotensin II
c. Vasopressin
*d. Dobutamine
Which of the following medications is a thrombolytic?
a. cangrelor
b. alteplase
c. clopidogrel
d. ticagrelor
e. bivalrudin
a. cangrelor
*b. alteplase
c. clopidogrel
d. ticagrelor
e. bivalrudin
Your patient in the hospital is currently receiving a morphine 2 mg/hr IV continuous infusion, with morphine 0.5 mg IV push q2h PRN breakthrough pain. They have received a total of 4 doses of the breakthrough morphine in the past 24h, which has been consistent over the past few days. The plan is to discharge this patient to a hospice facility with a transdermal fentanyl patch. What initial transdermal fentanyl patch dose would you recommend?
a. 25 mcg/hr patch
b. 50 mcg/hr patch
c. 75 mcg/hr patch
d. 100 mcg/hr patch
a. 25 mcg/hr patch
b. 50 mcg/hr patch
*c. 75 mcg/hr patch
d. 100 mcg/hr patch
Which of the following is the most common drug-induced heme disorder, caused by medications such as unfractionated heparin?
a. Agranulocytosis
b. Hemolytic anemia
c. Megaloblastic anemia
d. Thrombocytopenia
a. Agranulocytosis
b. Hemolytic anemia
c. Megaloblastic anemia
*d. Thrombocytopenia
Which of the following components of the ICU flight checklist “FAST HUG” relates to sedation needs in the critical care environment?
a. F
b. A
c. S
d. T
e. H
f. U
g. G
a. F
b. A
*c. S
d. T
e. H
f. U
g. G
Which of the following accurately describes the pathophysiology of diabetic ketoacidosis (DKA)?
a. Insulin response is increased, causing an increase in free fatty acids and ketone bodies
b. Insulin response is increased, causing a decrease in free fatty acids and ketone bodies
c. Insulin response production is decreased, causing a decrease in free fatty acids and ketone bodies
d. Insulin response is decreased, causing an increase in free fatty acids and ketone bodies
a. Insulin response is increased, causing an increase in free fatty acids and ketone bodies
b. Insulin response is increased, causing a decrease in free fatty acids and ketone bodies
c. Insulin response production is decreased, causing a decrease in free fatty acids and ketone bodies
*d. Insulin response is decreased, causing an increase in free fatty acids and ketone bodies
Which sedative infusion should be avoided in patients with egg allergies?
a. Propofol
b. Hydromorphone
c. Dexmedetomidine
d. Midazolam
*a. Propofol
b. Hydromorphone
c. Dexmedetomidine
d. Midazolam
How soon should antibiotics be initiated once septic shock is recognized?
a. Within 1 hour
b. Within 2 hours
c. Within 24 hours
*a. Within 1 hour
b. Within 2 hours
c. Within 24 hours
Alteplase use is most commonly associated with a high risk of which adverse effect?
a. ischemic stroke
b. bleeding
c. arrhythmia
d. hypertension
a. ischemic stroke
*b. bleeding
c. arrhythmia
d. hypertension
Which agent for oropharyngeal secretions does not cross the blood brain barrier and has the least amount of central anticholinergic side effects compared to other agents?
a. Atropine
b. Scopolamine
c. Glycopyrrolate
d. Methylnaltrexone
a. Atropine
b. Scopolamine
*c. Glycopyrrolate
d. Methylnaltrexone
Which of the following medications are given as a means of supportive care for agranulocytosis?
a. B12 supplement
b. corticosteroids
c. G-CSFs
d. fondaparinux
a. B12 supplement
b. corticosteroids
*c. G-CSFs
d. fondaparinux
Which of the following is accurate regarding appropriate sedation considerations in the critical care setting?
a. Fentanyl has both sedating and analgesic effects
b. The primary purpose is to assist patients who experience insomnia in the ICU
c. A RASS score of 0 indicates that the patient is unarousable
d. Deep sedation is preferred to maximize patient outcomes
*a. Fentanyl has both sedating and analgesic effects
b. The primary purpose is to assist patients who experience insomnia in the ICU
c. A RASS score of 0 indicates that the patient is unarousable
d. Deep sedation is preferred to maximize patient outcomes
Which of the following is true when comparing diabetic ketoacidosis (DKA) and hyperosmolar nonketotic state (HHS)?
a. DKA is more common with type 2 diabetes while HHS is more common with type 1 diabetes
b. polydipsia, polyuria, and polyphagia are signs and symptoms typically observed with HHS and not DKA
c. An initial treatment strategy for both DKA and HHS is fluid resuscitation to restore intravascular volume
d. A plasma glucose of >600 mg/dL is required for the diagnosis of either DKA or HHS
a. DKA is more common with type 2 diabetes while HHS is more common with type 1 diabetes
b. polydipsia, polyuria, and polyphagia are signs and symptoms typically observed with HHS and not DKA
* c. An initial treatment strategy for both DKA and HHS is fluid resuscitation to restore intravascular volume
d. A plasma glucose of >600 mg/dL is required for the diagnosis of either DKA or HHS
What would be the best pain option for a patient who is mechanically ventilated in the ICU, post abdominal surgery, with concerns for acute kidney injury?
a. IV acetaminophen
b. PO gabapentin
c. IV morphine
d. IV ketorolac
*a. IV acetaminophen
b. PO gabapentin
c. IV morphine
d. IV ketorolac
James is a 68 y/o male patient who experiences a STEMI and codes en route to the hospital. Upon arrival to the ICU, he is fluid resuscitated and placed on a ventilator to protect his airway. He is started on norepinephrine, but even when the dose is maximized (> 15 mcg/min) he remains unstable (BP = 76/45 mm Hg, HR = 38 bpm). Which of the following strategies would be the most appropriate recommendation for escalating treatment?
a. initiate blood transfusion
b. add vasopressin
c. switch to milrinone
d. start empiric antibiotics
a. initiate blood transfusion
*b. add vasopressin
c. switch to milrinone
d. start empiric antibiotics
A fellow student on rotation asks you to distinguish acute ischemic stroke from a hemmoragic stroke. What would you find in a cerebral artery of a patient having an acute ischemic stroke?
Clot
Your patient is receiving MS Contin 60 mg PO q12h, and morphine oral solution 10 mg q4h PRN breakthrough pain. She has been using about 4 doses of the oral morphine solution each day which has been keeping her comfortable. Unfortunately, she is having difficulty swallowing the MS Contin tablets and the plan is to switch her long-acting regimen to a transdermal fentanyl patch. What initial transdermal fentanyl patch dose would you recommend?
a. 25 mcg/hr patch
b. 50 mcg/hr patch
c. 75 mcg/hr patch
d. 100 mcg/hr patch
a. 25 mcg/hr patch
*b. 50 mcg/hr patch
c. 75 mcg/hr patch
d. 100 mcg/hr patch
Kylie is a 26 y/o female who consistently takes acetaminophen and calcium carbonate (Tums) for self-management of headaches and heartburn. She has a past medical history of hypothyroidism and gastroesophageal reflux disease (GERD). She currently takes a hormonal contraceptive which precipitates amenorrhea (she does not menstruate, currently is not lactating). Which of the following types of anemia is she at greatest risk for?
a. Megaloblastic anemia due to B12 deficiency
b. Megaloblastic anemia due to B9 deficiency
c. Iron deficiency anemia (IDA)
*a. Megaloblastic anemia due to B12 deficiency
b. Megaloblastic anemia due to B9 deficiency
c. Iron deficiency anemia (IDA)
Which of the following medications used for stress ulcer prophylaxis acts by creating a protective coating around the ulcer?
a. calcium carbonate
b. sucralfate
c. lansoprazole
d. randitidine
a. calcium carbonate
*b. sucralfate
c. lansoprazole
d. randitidine
Justin is a 60 yo male diagnosed with diabetes, admitted to the emergency department with hyperosmolar nonketotic state (HHS). You are the pharmacist on his care team and are asked what the target maintenance blood sugar range should be for Justin. Which of the following is the most appropriate response?
a. 250-300 mg/dL
b. 75 - 150 mg/dL
c. 50 - 75 mg/dL
* a. 250-300 mg/dL
b. 75 - 150 mg/dL
c. 50 - 75 mg/dL
A patient who is mechanically ventilated in the ICU has grimaced facial expressions and muscle tension when wound care is being provided by the wound care team each day. They do not indicate significant pain at any other time on the CPOT scale during the nursing shift. What would be the most appropriate administration of pain medications for this patient?
a. continuous IV infusion
b. intermittent injection
c. patient-controlled analgesia
d. opioid transdermal patch
a. continuous IV infusion
*b. intermittent injection
c. patient-controlled analgesia
d. opioid transdermal patch
Amber is a 55 y/o female admitted to the ICU for severe fatigue, somnolence, confusion, anuria, pale lips and pale finger beds. Upon evaluation, she is found to be dehydrated and hemorrhaging from a bowel perforation. Her care team estimates that she has gradually lost about 2 liters of blood in the last 24 hours. Based on this information, what type of shock does Amber likely have?
a. distributive
b. obstructive
c. hypovolemic
d. cardiogenic
a. distributive
b. obstructive
*c. hypovolemic
d. cardiogenic
Jackie is a 45-year-old man with acute onset of chest pain and shortness of breath. He is currently on an ambulance bound for a hospital without PCI capabilities. Which test result is necessary to determine Jackie's eligibility for thrombolityic therapy?
a. Non-contrast CT
b. ECG
c. Troponin
d. D-dimer
a. Non-contrast CT
*b. ECG
c. Troponin
d. D-dimer
A physician asks you how to prescribe "intensol" oral morphine sulfate solution (100mg/5 mL) for a patient on hospice. They would like to prescribe 20 mg PO morphine every 4 hours PRN pain or dyspnea. What volume of the intended concentration would make a dose of 20 mg oral morphine sulfate? Include units in your answer.
Answer: 1 mL
Kourtney was recently diagnosed with macrocytic anemia caused by a deficiency in folate (vitamin B9). Which of the following doses of folic acid is most appropriate for her to receive?
a. 1 mg daily
b. 2 mg daily
c. 2 mg twice daily
d. 10 mg daily
* a. 1 mg daily
b. 2 mg daily
c. 2 mg twice daily
d. 10 mg daily
Julie is a 62-year-old female with type 2 diabetes recently admitted to surgical ICU for recovery after an amputation related to a diabetic foot infection. During the course of her stay, her nurse notes her blood sugar falls to 52 mg/dL. Which of the following appropriately classifies her glycemic control status based on her blood sugar?
a. hyperglycemia
b. normoglycemia
c. mild-moderate hypoglycemia
d. severe hypoglycemia
a. hyperglycemia
b. normoglycemia
* c. mild-moderate hypoglycemia
d. severe hypoglycemia
Which of the following accurately describes the pathophysiology of diabetic ketoacidosis (DKA)?
a. Insulin response is increased, causing an increase in free fatty acids and ketone bodies
b. Insulin response is increased, causing a decrease in free fatty acids and ketone bodies
c. Insulin response is decreased, causing a decrease in fatty acids and ketone bodies
d. Insulin response is decreased, causing an increase in free fatty acids and ketone bodies
a. Insulin response is increased, causing an increase in free fatty acids and ketone bodies
b. Insulin response is increased, causing a decrease in free fatty acids and ketone bodies
c. Insulin response is decreased, causing a decrease in fatty acids and ketone bodies
*d. Insulin response is decreased, causing an increase in free fatty acids and ketone bodies
Which opioid infusion has the highest risk of hypotension due to histamine release?
a. Fentanyl
b. Morphine
c. Hydromorphone
d. Remifentanil
a. Fentanyl
*b. Morphine
c. Hydromorphone
d. Remifentanil
Paul is a 35 yo male who presents to the emergency department (ED) with shortness of breath. He ran out of his rivaroxaban (Xarelto) 2 weeks ago due to his loss of insurance coverage and inability to afford the medication. He was prescribed Xarelto to treat a DVT he developed 2 months ago. His care team notes that he is growing increasingly confused and somnolent and decides to admit due to a massive pulmonary embolism. If this is the case, which of the following types of shock would Paul most likely be experiencing?
a. cardiogenic
b. hypovolemia
c. obstructive
d. distributive
a. cardiogenic
b. hypovolemia
* c. obstructive
d. distributive
Which of the following is outside the time window to receive tenecteplace (TNK) for ST-Elevation Myocardial Infarction?
a. 20 minutes
b. 3 hours
c. 120 minutes
d. 1.5 hours
a. 20 minutes
*b. 3 hours
c. 120 minutes
d. 1.5 hours