CHPN CHPN - Certified Hospice and Palliative Nurse Medications and Pharmacology 3

Question 1

A patient on long-term opioid therapy develops myoclonus (muscle jerking). Which action is MOST appropriate?

Accepted Answer

Consider opioid rotation and ensure adequate hydration

Answer

Immediately discontinue all opioids

Answer

Increase the opioid dose to improve pain control

Answer

Administer naloxone to reverse the opioid effect

Question 2

Which statement about naloxone (Narcan) use in hospice is MOST accurate?

Accepted Answer

Naloxone should be titrated carefully in hospice to reverse sedation without precipitating severe pain

Answer

Naloxone should be given routinely to all hospice patients on opioids

Answer

Naloxone is contraindicated in all hospice patients

Answer

Full reversal doses of naloxone should always be given to achieve maximum reversal

Question 3

A hospice patient with renal failure is on morphine. The nurse should monitor closely for signs of toxicity because:

Accepted Answer

Morphine-6-glucuronide, an active metabolite, accumulates in renal failure causing CNS toxicity

Answer

Renal failure causes morphine to be excreted faster

Answer

Renal failure decreases the pain-relieving effect of morphine

Answer

IV morphine is contraindicated in renal failure

Question 4

What is the PRIMARY purpose of using a bowel protocol (e.g., senna + docusate) when initiating opioid therapy?

Accepted Answer

To prevent opioid-induced constipation

Answer

To prevent nausea

Answer

To enhance opioid absorption

Answer

To treat diarrhea caused by high-dose opioids

Question 5

A patient in the last 24–48 hours of life is experiencing refractory dyspnea unrelieved by oxygen or low-dose opioids. Which medication class is most appropriate to add?

Accepted Answer

Benzodiazepines (e.g., lorazepam)

Answer

NSAIDs

Answer

Antihistamines

Answer

Diuretics

Question 6

Which of the following is the MOST appropriate indication for initiating palliative sedation?

Accepted Answer

Refractory symptoms causing intolerable suffering unresponsive to all other treatments

Answer

Patient requests sleep to avoid family interactions

Answer

Mild anxiety in a newly admitted hospice patient

Answer

Pain that has not yet been treated with opioids