CHPN CHPN - Certified Hospice and Palliative Nurse Medications and Pharmacology

Question 1

What is the recommended first-line opioid for moderate-to-severe pain management in hospice patients with normal renal function?

Accepted Answer

Morphine sulfate

Answer

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?

Accepted Answer

5 mg IV

Answer

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)?

Accepted Answer

Glycopyrrolate (Robinul)

Answer

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?

Accepted Answer

5–15%

Answer

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?

Accepted Answer

Constipation

Answer

Unlike sedation, nausea, and respiratory depression, opioid-induced constipation does not resolve with tolerance and requires consistent prophylactic bowel management.

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