ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Non-Pain Symptom Assessment Questions and Answers — Questions and Answers
Question 1: An advanced practice nurse is caring for a 78-year-old male with end-stage COPD who is non-verbal. The patient appears restless, with a respiratory rate of 28, use of accessory muscles, and a distressed facial expression. Which of the following is the most appropriate tool to assess this patient's dyspnea?
- Numeric Rating Scale (NRS)
- Edmonton Symptom Assessment System (ESAS-r)
- Respiratory Distress Observation Scale (RDOS) (Correct answer)
- Borg Scale
Correct answer: Respiratory Distress Observation Scale (RDOS)
The Respiratory Distress Observation Scale (RDOS) is the most appropriate tool because it is specifically designed and validated for assessing respiratory distress in patients who are unable to self-report their symptoms. The other options, NRS, ESAS-r, and the Borg Scale, all require the patient to self-report the severity of their dyspnea.
Question 2: A 65-year-old patient with advanced pancreatic cancer reports new-onset, persistent nausea without vomiting. The patient also complains of a constant feeling of fullness after eating very little. Which of the following is the most likely cause of this patient's nausea?
- Anxiety
- Opioid medication side effect
- Hypercalcemia
- Impaired gastric emptying (Correct answer)
Correct answer: Impaired gastric emptying
The combination of persistent nausea, early satiety, and a feeling of fullness points towards impaired gastric emptying or gastroparesis, which is a common complication in advanced pancreatic cancer due to tumor infiltration or autonomic neuropathy. While the other options can cause nausea, the specific constellation of symptoms makes impaired gastric emptying the most probable etiology.
Question 3: The Memorial Delirium Assessment Scale (MDAS) is a clinician-rated tool used frequently in palliative care. What is its primary purpose?
- To differentiate delirium from dementia and depression.
- To screen for underlying causes of cognitive changes.
- To quantify the severity of delirium and monitor its course. (Correct answer)
- To guide non-pharmacological interventions for confusion.
Correct answer: To quantify the severity of delirium and monitor its course.
The primary purpose of the MDAS is to provide a quantitative assessment of the severity of delirium symptoms and to track changes in severity over time in response to interventions. While it can help in the diagnostic process, its main strength is in rating severity and monitoring the clinical course. A total score of 13 or greater is generally indicative of delirium.
Question 4: When assessing a hospice patient for constipation, which piece of information is most crucial for the advanced practice nurse to obtain first?
- The date of the last bowel movement.
- The patient's usual and current bowel pattern. (Correct answer)
- The presence of bowel sounds in all four quadrants.
- The patient's daily fluid and fiber intake.
Correct answer: The patient's usual and current bowel pattern.
Constipation is defined relative to the individual's normal pattern. Therefore, the most critical initial step is to establish the patient's baseline or usual bowel habit and compare it to their current pattern. This subjective information is key because what constitutes constipation varies significantly from person to person.
Question 5: A patient is completing the Edmonton Symptom Assessment System-revised (ESAS-r). The nurse should instruct the patient to rate the severity of the symptoms based on their experience during which timeframe?
- Over the past 24 hours
- On average over the past week
- At this present moment ('now') (Correct answer)
- At its worst in the past 3 days
Correct answer: At this present moment ('now')
The ESAS-r is designed to capture a snapshot of the patient's symptom severity at a specific point in time. The instructions explicitly ask patients to rate how they feel 'now'. This allows for consistent tracking of symptoms over time and assessment of immediate responses to interventions.
Question 6: Which of the following is a key principle in the assessment of nausea and vomiting in a patient with a serious illness?
- Initiate a broad-spectrum antiemetic before a full assessment is complete.
- Nausea and vomiting should be considered a single symptom.
- Prioritize objective signs like vomiting over the subjective report of nausea.
- Identify the likely underlying cause and emetic pathway to guide treatment. (Correct answer)
Correct answer: Identify the likely underlying cause and emetic pathway to guide treatment.
A thorough assessment to identify the underlying cause and the specific emetic pathway (e.g., chemoreceptor trigger zone, gastrointestinal, vestibular, cerebral cortex) is crucial for selecting the most effective antiemetic. Nausea and vomiting are often multifactorial, and treatment should be targeted at the specific mechanism. Nausea is a subjective experience and should be prioritized, and it is distinct from the physical act of vomiting.
ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Non-Pain Symptom Assessment Questions and Answers
An advanced practice nurse is caring for a 78-year-old male with end-stage COPD who is non-verbal.
The patient appears restless, with a respiratory rate of 28, use of accessory muscles, and a distressed facial expression.
Which of the following is the most appropriate tool to assess this patient's dyspnea?