CHPN CHPN - Certified Hospice and Palliative Nurse Medications and Pharmacology 2 — Questions and Answers
Question 1: Haloperidol (Haldol) is commonly used in hospice primarily for which symptom?
- Pain
- Terminal agitation and delirium (Correct answer)
- Respiratory secretions
- Constipation
Correct answer: Terminal agitation and delirium
Haloperidol is the most frequently used antipsychotic in hospice for managing terminal agitation, delirium, and nausea unresponsive to other agents.
Question 2: When a hospice patient can no longer swallow oral medications, which route is generally preferred for ongoing symptom management?
- Intramuscular
- Intravenous via PICC line
- Subcutaneous continuous infusion (Correct answer)
- Rectal suppositories only
Correct answer: Subcutaneous continuous infusion
Subcutaneous continuous infusion (via a syringe driver or pump) is the preferred route in hospice when oral medications can no longer be used, as it is comfortable and easy to manage at home.
Question 3: A nurse is preparing to titrate a continuous morphine infusion for a patient in uncontrolled pain. What is the standard recommendation for opioid dose titration?
- Double the dose every hour until pain is controlled
- Increase by 25–50% of the current dose when pain is not controlled (Correct answer)
- Decrease the dose and add a non-opioid adjuvant
- Switch to a different opioid class immediately
Correct answer: Increase by 25–50% of the current dose when pain is not controlled
Standard opioid titration calls for a 25–50% dose increase when the current dose is ineffective, balancing efficacy with safety.
Question 4: Which medication is considered the drug of choice for neuropathic pain in palliative care?
- Ibuprofen
- Acetaminophen
- Gabapentin (Neurontin) (Correct answer)
- Codeine
Correct answer: Gabapentin (Neurontin)
Gabapentin is a first-line agent for neuropathic pain (burning, shooting, or electric-type pain) commonly seen in advanced malignancy and other terminal conditions.
Question 5: A hospice patient taking methadone for pain requires careful monitoring because methadone has:
- A very short half-life requiring dosing every 2 hours
- An unpredictable and long half-life that increases risk of accumulation and overdose (Correct answer)
- No interaction with other CNS depressants
- A ceiling effect similar to non-opioid analgesics
Correct answer: An unpredictable and long half-life that increases risk of accumulation and overdose
Methadone has an unpredictable half-life (ranging from 8 to 80 hours), which creates significant risk of drug accumulation and delayed respiratory depression.
Question 6: Dexamethasone is commonly used in palliative care for all of the following EXCEPT:
- Reducing inflammation around brain metastases
- Stimulating appetite
- Managing spinal cord compression
- Treating opioid-induced constipation (Correct answer)
Correct answer: Treating opioid-induced constipation
Dexamethasone is used for inflammation, appetite stimulation, and spinal cord compression, but it has no role in treating opioid-induced constipation.
CHPN CHPN - Certified Hospice and Palliative Nurse Medications and Pharmacology 2
Haloperidol (Haldol) is commonly used in hospice primarily for which symptom?