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

Opioid-induced myoclonus, often caused by metabolite accumulation, is managed by rotating to a different opioid and ensuring adequate hydration to clear metabolites.

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

In hospice, if naloxone is needed, it should be diluted and titrated to restore adequate ventilation without completely reversing analgesia, which would precipitate severe pain.

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

Morphine-6-glucuronide (M6G), the active metabolite of morphine, accumulates in renal failure and can cause prolonged sedation and respiratory depression.

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

Stimulant laxatives (senna) combined with stool softeners (docusate) are given prophylactically with opioids because opioid-induced constipation does not resolve with tolerance.

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

Benzodiazepines such as lorazepam are added to opioids to reduce the anxiety component of refractory dyspnea and provide comfort in the final hours.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

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