Quiz 9: Management of respiratory and gastrointestinal symptoms

Please choose the one, most correct answer to each question or statement.

1. What is a sign?
   • A clinical observation that indicates the presence of an illness or disease
   • Anorexia or depression
   • Pain or discomfort
   • Any sensation or feeling that is only experienced by a patient
2. What is a symptom?
   • A common cause of abdominal pain and distension
   • Any sensation or feeling that is experienced only by a patient
   • A clinical observation that is made by a doctor
   • An abdominal mass or heart murmur
3. Common symptoms experienced by children needing palliative care include:
   • Pyrexia and tachycardia
   • Hypertension or hypotension
   • Large masses or tumours
   • Breathlessness, nausea and constipation
4. A principle of symptom management is:
   • Only treat if the symptoms are severe
   • Only treat if the child also has clinical signs
   • Use both non-pharmacological and pharmacological management when treating a symptom
   • Give a good explanation to the family but there is no need to treat the child
5. Which of these is one of the four golden rules when assessing symptoms?
   • Make a thorough assessment
   • Ask the parents what the child complains of
   • Give an explanation to the family of what you are assessing
   • Use pharmacological rather than non-pharmacological strategies to treat the patient’s symptoms
6. Shortness of breath can be made worse by:
   • Depression
   • Nausea and vomiting
   • Anxiety
   • Insomnia
7. Shortness of breath that is severe in end-of-life care can be treated pharmacologically with:
   • A low dose of morphine
   • Nebulisation with saline
   • Physiotherapy
   • Aromatherapy
8. The noise made by excessive secretions at the end-of-life is also referred to as:
   • The death rattle
   • Blowing bubbles
   • Grunting
   • Noisy breathing
9. Excessive secretions at the end-of-life are caused by:
   • Drinking too much milk
   • Treatment with a diuretic
   • Taking in excessive amounts of clear fluids
   • The child’s inability to cough or swallow secretions
10. A way to manage excessive secretions at the end-of-life include:
    • Continuous deep suctioning
    • Using only medication to dry up secretions
    • Roll the patient onto the side to facilitate drainage of secretions
    • Giving extra fluids to make sections thinner
11. Nausea and vomiting are triggered via receptors in:
    • The gastrointestinal tract only
    • The gastrointestinal tract, the brain and the vestibular apparatus
    • The brain only
    • The vestibular apparatus only
12. A possible underlying cause of projectile vomiting could be:
    • Hiccups
    • A urinary tract infection
    • Raised inter cranial pressure
    • Pneumonia
13. A strategy to help manage nausea and vomiting may include:
    • Giving the child prune juice to drink
    • Keeping the child nil per mouth for 24 hours
    • Offering small meals and avoid exposing the child to strong odours
    • Include spicy foods into the diet
14. A prokinetic such as metoclopramide given for nausea and vomiting works on the:
    • Vomiting centre
    • The chemo-receptor trigger zone
    • Vestibular apparatus
    • The gastrointestinal tract
15. An anti-emetic that works on the chemo-receptor-zone is:
    • Haloperidol
    • Maxolon
    • Cyclizine
    • Metoclopramide
16. Cyclizine is an anti-emetic which works on the:
    • Chemo-receptor trigger zone
    • The gastrointestinal tract
    • The vomiting centre in the brain
    • The vestibular apparatus
17. A common cause of constipation is due to:
    • The side effects of medication such as opioids
    • The use of anti-emetics
    • Over hydration
    • The use of anti-inflammatories
18. Constipation needs to first be managed by:
    • Immediately starting a laxative
    • Reducing fluids and fibre in the diet
    • Giving an enema to clear the bowel
    • Treating and correcting any underlying causes or reversible factors where possible
19. To prevent constipation:
    • Use a different laxative daily
    • Encourage regular daily bowel routines
    • Cut down on protein in the child’s diet
    • Give a suppository once a week
20. When starting a child on a laxative regime, begin with the following laxative first:
    • An enema to clear out the rectum
    • A bowel stimulant like bisacodyl suppositories
    • An osmotic laxative like lactulose to soften the stool
    • A glycerine suppository