AMSN Pain Management and Palliative Care 2 — Questions and Answers
Question 1: A dying patient's family asks why the nurse is administering morphine for dyspnea when the patient is not in pain. The best response is:
- 'Morphine is only for pain; I'll check the order again.'
- 'Low-dose morphine reduces the sensation of air hunger in dying patients without hastening death when used appropriately.' (Correct answer)
- 'We are using morphine to help the patient die more comfortably and quickly.'
- 'This medication will keep the patient sedated so the family can have peace.'
Correct answer: 'Low-dose morphine reduces the sensation of air hunger in dying patients without hastening death when used appropriately.'
Low-dose opioids are evidence-based for relieving dyspnea in terminal illness by reducing the brain's response to hypercapnia and the sensation of breathlessness.
Question 2: A patient receiving high-dose opioids for cancer pain is concerned about addiction. The nurse's best response is:
- 'Your concern is valid — opioids always lead to addiction.'
- 'Physical dependence is expected with long-term opioids, but addiction (compulsive misuse despite harm) is rare in cancer pain patients taking opioids as prescribed.' (Correct answer)
- 'You should be worried — we will start weaning your dose immediately.'
- 'Addiction doesn't apply to cancer patients so don't worry about it.'
Correct answer: 'Physical dependence is expected with long-term opioids, but addiction (compulsive misuse despite harm) is rare in cancer pain patients taking opioids as prescribed.'
Distinguishing physical dependence (expected physiological adaptation) from addiction (psychological disorder with compulsive misuse) is essential patient education in pain management.
Question 3: A patient in hospice care becomes increasingly confused, restless, and distressed in the final days of life. The nurse recognizes this as:
- Severe medication overdose
- Terminal restlessness (terminal delirium), a common end-of-life phenomenon (Correct answer)
- A sign of undertreated pain requiring dose escalation
- Normal sleep pattern changes
Correct answer: Terminal restlessness (terminal delirium), a common end-of-life phenomenon
Terminal restlessness is a common end-of-life syndrome characterized by agitation, confusion, and distress that often responds to low-dose haloperidol or benzodiazepines.
Question 4: A palliative care patient declines a recommended blood transfusion, stating it conflicts with their religious beliefs. The nurse's appropriate response is:
- Administer the transfusion anyway because the patient needs it to survive
- Respect the patient's decision and document their refusal, ensuring informed consent principles are upheld (Correct answer)
- Contact ethics to override the patient's decision
- Pressure the family to convince the patient to accept the transfusion
Correct answer: Respect the patient's decision and document their refusal, ensuring informed consent principles are upheld
Competent adult patients have the right to refuse any medical treatment; the nurse's role is to ensure the decision is informed and to document it, respecting patient autonomy.
Question 5: A family member asks the nurse to 'not tell my mother she has terminal cancer' to protect her feelings. The nurse should:
- Agree and withhold the diagnosis from the patient
- Explain that the patient has the right to know her diagnosis and discuss goals of care; involve the palliative care team (Correct answer)
- Avoid the topic and hope the patient doesn't ask
- Tell the patient immediately without family present
Correct answer: Explain that the patient has the right to know her diagnosis and discuss goals of care; involve the palliative care team
Patient autonomy requires truthful disclosure of the diagnosis; the nurse should involve the multidisciplinary palliative care team to facilitate sensitive family-patient communication.
Question 6: A patient with advanced heart failure is transitioned to comfort-focused care. Which order would the nurse anticipate discontinuing?
- Morphine sulfate PRN for dyspnea
- Daily lipid-lowering statin therapy (Correct answer)
- Oral opioids for pain management
- Mouth care and skin care
Correct answer: Daily lipid-lowering statin therapy
Preventive medications like statins that serve no immediate comfort purpose are typically discontinued in comfort-focused care to reduce the pill burden and focus on symptom management.
AMSN Pain Management and Palliative Care 2
A dying patient's family asks why the nurse is administering morphine for dyspnea when the patient is not in pain.
The best response is: