CHPN - Certified Hospice and Palliative Nurse Pain Management Strategies Questions and Answers

Question 1

A hospice patient with metastatic bone cancer reports a new type of pain described as 'burning' and 'tingling' in their lower extremities, which is not well-controlled by their current regimen of long-acting morphine.
Which of the following interventions would be most appropriate for the CHPN to anticipate?

Accepted Answer

Collaborating with the provider to add an adjuvant analgesic like gabapentin.

Answer

Requesting an order to increase the dose of the long-acting morphine.

Answer

Administering a non-steroidal anti-inflammatory drug (NSAID) for breakthrough pain.

Answer

Initiating a non-pharmacological intervention such as deep breathing exercises.

Question 2

A patient is being managed on Step 3 of the WHO analgesic ladder with a strong opioid for severe cancer pain. According to the foundational principles of the WHO ladder, which of the following is a key concept in managing this patient's pain effectively?

Accepted Answer

Giving analgesics 'by the clock' to maintain a stable level of pain control.

Answer

Administering analgesics only when the patient reports pain.

Answer

Using the parenteral route exclusively for strong opioids.

Answer

Discontinuing all non-opioid analgesics when a strong opioid is started.

Question 3

A CHPN is caring for a patient who has been on a stable dose of oral morphine for several weeks. The patient now presents with increasing confusion, myoclonus (muscle twitching), and tactile hallucinations. The nurse recognizes these as potential signs of which opioid-related complication?

Accepted Answer

Opioid-induced neurotoxicity

Answer

Opioid-induced constipation

Answer

Anaphylactic reaction

Answer

Serotonin syndrome

Question 4

Which of the following non-pharmacological interventions is a manipulative and body-based practice that a CHPN can employ to manage a patient's pain and provide comfort?

Accepted Answer

Gentle massage

Answer

Guided imagery

Answer

Music therapy

Answer

Aromatherapy

Question 5

A hospice nurse is initiating opioid therapy for a patient with severe, constant pain. To proactively manage the most common and persistent side effect of opioids, which of the following actions should the nurse prioritize?

Accepted Answer

Initiating a scheduled bowel regimen with a stimulant laxative.

Answer

Administering an antiemetic with the first dose.

Answer

Instructing the patient to report any signs of drowsiness.

Answer

Monitoring for respiratory depression every hour.

Question 6

A patient with end-stage COPD is experiencing significant pain and dyspnea. The care team decides to initiate a low-dose opioid. The patient's family expresses fear that using morphine will hasten the patient's death through respiratory depression. What is the CHPN's most appropriate response?

Accepted Answer

"When used in low, carefully managed doses for symptom control, the risk of significant respiratory depression is very low and studies show it is safe."

Answer

"We can use a non-opioid alternative like acetaminophen to avoid that risk."

Answer

"The principle of double effect ethically allows us to use opioids for comfort, even if it shortens life."

Answer

"That's a valid concern, but addiction is not a primary worry at this stage of life."