03-25-2010, 02:53 AM
While making rounds in a rehabilitation facility, you see a 76-year-old white woman who has been your patient for 25 years. One month ago she was diagnosed with metastatic non-small cell carcinoma of the lung with metastases to the other lung, liver and brain. She now has moderate left hemiparesis that limits walking. She also has multiple, asymptomatic, deep venous thrombi of both legs that are being treated with a vena caval filter. Despite discussion with the patient and her family about her illness, her son tells you that she is apparently unaware that her condition is terminal.
Item 1 of 2
7. Which of the following is the most appropriate next step?
A) Arranging transfer to the in-patient psychiatric ward
B) Beginning anxiolytic therapy
[C) Discussing the prognosis again with the patient]
D) Encouraging the family to discuss the patient's prognosis with her
E) Explaining to the son that it is inappropriate for you to speak about his mother's illness
Item 2 of 2
8. The patient is not in severe pain and she currently has no respiratory distress. She has chosen not to have further intervention and she probably has about 3 months to live. Her husband is an active 75-year-old man with recently diagnosed type 2 diabetes mellitus. Two of their three sons live 1 hour away. The patient has many concerned neighbors and friends. The patient's family asks for your advice regarding appropriate care for her for the remainder of her illness.
Which of the following is the most appropriate recommendation?
A) Continued care in the rehabilitation center until she is able to ambulate on her own
B) Home health care for as long as she qualifies for skilled nursing services
[C) Home hospice care with physical therapy]
D) Placement under intermediate (nonskilled) care in a local nursing home
E) Placement under skilled care in a local nursing home
Item 1 of 2
7. Which of the following is the most appropriate next step?
A) Arranging transfer to the in-patient psychiatric ward
B) Beginning anxiolytic therapy
[C) Discussing the prognosis again with the patient]
D) Encouraging the family to discuss the patient's prognosis with her
E) Explaining to the son that it is inappropriate for you to speak about his mother's illness
Item 2 of 2
8. The patient is not in severe pain and she currently has no respiratory distress. She has chosen not to have further intervention and she probably has about 3 months to live. Her husband is an active 75-year-old man with recently diagnosed type 2 diabetes mellitus. Two of their three sons live 1 hour away. The patient has many concerned neighbors and friends. The patient's family asks for your advice regarding appropriate care for her for the remainder of her illness.
Which of the following is the most appropriate recommendation?
A) Continued care in the rehabilitation center until she is able to ambulate on her own
B) Home health care for as long as she qualifies for skilled nursing services
[C) Home hospice care with physical therapy]
D) Placement under intermediate (nonskilled) care in a local nursing home
E) Placement under skilled care in a local nursing home