ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Pharmacologic Interventions in Palliation Questions and Answers

Question 1

An 82-year-old male with end-stage COPD is admitted to hospice for worsening dyspnea.
He is currently opioid-naïve.
Which of the following is the most appropriate initial pharmacologic intervention for managing his dyspnea?

Accepted Answer

Morphine sulfate immediate-release 2.5-5 mg orally every 4 hours as needed.

Answer

Nebulized morphine every 4 hours as needed

Answer

Lorazepam 0.5 mg sublingual every 6 hours as needed for anxiety

Answer

Oxygen at 4 L/min via nasal cannula continuously

Question 2

A patient with metastatic cancer to the bone reports severe, sharp, intermittent pain with movement, despite being on a stable long-acting opioid regimen. Which adjuvant medication would be most appropriate to target this type of incident bone pain?

Accepted Answer

Dexamethasone.

Answer

Gabapentin

Answer

Amitriptyline

Answer

Baclofen

Question 3

A 65-year-old patient with advanced pancreatic cancer is experiencing persistent nausea and vomiting, suspected to be due to delayed gastric emptying. Which of the following antiemetics would be the most appropriate first-choice medication?

Accepted Answer

Metoclopramide.

Answer

Ondansetron

Answer

Scopolamine

Answer

Lorazepam

Question 4

A patient in the terminal phase of life develops noisy, gurgling respirations ('death rattle') that are distressing to the family. Non-pharmacologic measures like repositioning have been ineffective. Which pharmacologic intervention is most appropriate to manage this symptom?

Accepted Answer

Prophylactic subcutaneous glycopyrrolate or scopolamine.

Answer

Administering a diuretic like furosemide

Answer

Increasing the dose of the patient's opioid

Answer

Starting a nebulized bronchodilator

Question 5

An ACHPN is caring for a patient with severe, refractory neuropathic pain from metastatic cancer. The patient has had inadequate relief and limiting side effects from high doses of morphine and a trial of gabapentin. Which of the following opioids would be a logical next choice due to its unique mechanism of action for neuropathic pain?

Accepted Answer

Methadone.

Answer

Hydromorphone

Answer

Fentanyl

Answer

Oxycodone

Question 6

A hospice patient with advanced dementia develops hyperactive delirium with agitation that is distressing and poses a safety risk. Non-pharmacologic interventions have failed. Which of the following represents the most appropriate initial pharmacologic approach?

Accepted Answer

Initiating a low-dose antipsychotic such as haloperidol.

Answer

Administering lorazepam as a standalone first-line agent

Answer

Starting a scheduled dose of an antidepressant like sertraline

Answer

Requesting a palliative sedation consultation immediately