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

The patient's description of 'burning' and 'tingling' pain is characteristic of neuropathic pain. While opioids are effective for nociceptive pain, neuropathic pain often requires the addition of an adjuvant analgesic. Gabapentin, an anticonvulsant, is a first-line treatment for neuropathic pain and is commonly used in conjunction with opioids to improve pain control.

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

A core principle of the WHO analgesic ladder is to administer analgesics 'by the clock,' meaning at regular, scheduled intervals, rather than waiting for the patient to experience pain. This proactive approach prevents breakthrough pain and maintains a more consistent state of comfort. The oral route is preferred whenever possible, and non-opioids or other adjuvants may be continued.

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

The cluster of symptoms including cognitive changes (confusion, hallucinations) and neuromuscular excitation (myoclonus) are classic signs of opioid-induced neurotoxicity (OIN). This can occur with the accumulation of opioid metabolites. Management often involves hydration, dose reduction, or rotating to a different opioid like fentanyl or methadone.

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

Gentle massage is a manipulative, body-based therapy that can help ease muscle tension, improve circulation, and promote relaxation, thereby reducing pain perception. While guided imagery, music therapy, and aromatherapy are valuable non-pharmacological interventions, they are classified differently (e.g., mind-body or sensory therapies) and do not primarily involve physical manipulation of the body's tissues.

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

Constipation is the most common and persistent side effect of opioid therapy, as tolerance does not typically develop. Therefore, a proactive, scheduled bowel regimen (e.g., a stimulant laxative like senna with or without a stool softener) should be initiated simultaneously with the opioid to prevent opioid-induced constipation (OIC). While nausea and sedation can occur, tolerance often develops within a few days.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

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