CHPN CHPN - Certified Hospice and Palliative Nurse Medications and Pharmacology 1 — Questions and Answers
Question 1: What is the recommended first-line opioid for moderate-to-severe pain management in hospice patients with normal renal function?
- Meperidine (Demerol)
- Morphine sulfate (Correct answer)
- Codeine
- Tramadol
Correct answer: Morphine sulfate
Morphine sulfate is the gold standard first-line opioid for moderate-to-severe pain in hospice due to its efficacy, familiarity, and multiple available routes.
Question 2: A hospice patient receiving oral morphine 15 mg every 4 hours is being converted to an equianalgesic IV dose. What is the correct IV morphine equivalent?
- 15 mg IV
- 10 mg IV
- 5 mg IV (Correct answer)
- 7.5 mg IV
Correct answer: 5 mg IV
The oral-to-IV morphine conversion ratio is 3:1, so 15 mg oral morphine equals 5 mg IV morphine.
Question 3: Which medication is most commonly used in hospice to reduce excessive respiratory secretions (death rattle)?
- Haloperidol
- Lorazepam
- Glycopyrrolate (Robinul) (Correct answer)
- Dexamethasone
Correct answer: Glycopyrrolate (Robinul)
Glycopyrrolate is an anticholinergic agent that reduces secretion production without crossing the blood-brain barrier, making it preferred for death rattle.
Question 4: A patient on a fentanyl transdermal patch requires breakthrough pain dosing. The appropriate breakthrough dose is calculated as what percentage of the 24-hour opioid total?
- 1–2%
- 5–15% (Correct answer)
- 25–30%
- 50%
Correct answer: 5–15%
Breakthrough (rescue) doses are typically 5–15% of the total 24-hour opioid dose, administered every 1–4 hours as needed.
Question 5: Which adverse effect of opioids does NOT develop tolerance over time and requires ongoing management throughout therapy?
- Sedation
- Nausea
- Constipation (Correct answer)
- Respiratory depression
Correct answer: Constipation
Unlike sedation, nausea, and respiratory depression, opioid-induced constipation does not resolve with tolerance and requires consistent prophylactic bowel management.
Question 6: A hospice patient is prescribed lorazepam 0.5 mg sublingual every 4 hours PRN for anxiety. Which finding would prompt the nurse to hold this medication?
- Respiratory rate of 18 breaths per minute
- Blood pressure of 100/60 mmHg
- Respiratory rate of 8 breaths per minute and oxygen saturation of 85% (Correct answer)
- Complaint of dry mouth
Correct answer: Respiratory rate of 8 breaths per minute and oxygen saturation of 85%
Significant respiratory depression (RR 8 and SpO2 85%) is a contraindication to benzodiazepine administration and warrants holding the dose and notifying the provider.
CHPN CHPN - Certified Hospice and Palliative Nurse Medications and Pharmacology 1
What is the recommended first-line opioid for moderate-to-severe pain management in hospice patients with normal renal function?