CHPN CHPN - Certified Hospice and Palliative Nurse Non-Pain Symptom Management Questions and Answers 2 — Questions and Answers
Question 1: A hospice patient with advanced heart failure develops Cheyne-Stokes respirations. What is the most appropriate nursing intervention?
- Administer supplemental oxygen at high flow
- Position the patient for comfort and educate the family that this is a normal end-of-life pattern (Correct answer)
- Suction the airway every 15 minutes
- Administer a bronchodilator nebulizer treatment
Correct answer: Position the patient for comfort and educate the family that this is a normal end-of-life pattern
Cheyne-Stokes respirations are a common end-of-life breathing pattern, and the priority is comfort positioning and family education rather than aggressive interventions.
Question 2: Which medication is most commonly used to manage terminal secretions (death rattle) in hospice patients?
- Albuterol
- Glycopyrrolate (Correct answer)
- Furosemide
- Dexamethasone
Correct answer: Glycopyrrolate
Glycopyrrolate is an anticholinergic agent that reduces secretion production and is a first-line treatment for terminal secretions.
Question 3: A patient with end-stage liver disease develops ascites causing significant abdominal distension and dyspnea. What non-pharmacological intervention may provide the most relief?
- Restricting all oral fluids
- Therapeutic paracentesis (Correct answer)
- Applying abdominal binders tightly
- Elevating the foot of the bed
Correct answer: Therapeutic paracentesis
Therapeutic paracentesis directly removes accumulated fluid from the peritoneal cavity, providing immediate relief of pressure-related symptoms.
Question 4: A hospice nurse is caring for a patient experiencing intractable hiccups lasting over 48 hours. Which medication may be prescribed to manage this symptom?
- Ondansetron
- Chlorpromazine (Correct answer)
- Diphenhydramine
- Acetaminophen
Correct answer: Chlorpromazine
Chlorpromazine is FDA-approved for intractable hiccups and acts on the hiccup reflex arc through dopamine receptor blockade.
Question 5: What is the primary goal of managing xerostomia (dry mouth) in a hospice patient who is no longer taking oral fluids?
- Restoring normal saliva production through hydration
- Preventing aspiration pneumonia
- Providing comfort and maintaining oral mucosa integrity (Correct answer)
- Ensuring the patient can resume oral medications
Correct answer: Providing comfort and maintaining oral mucosa integrity
In hospice care, managing xerostomia focuses on comfort through mouth care, moisturizers, and maintaining mucosal integrity rather than curative goals.
Question 6: A patient with advanced COPD on hospice is experiencing severe anxiety and air hunger despite maximal bronchodilator therapy. What is the most appropriate next pharmacological intervention?
- Increase the bronchodilator frequency to every 2 hours
- Administer a low-dose opioid such as morphine (Correct answer)
- Start an SSRI antidepressant for anxiety
- Initiate continuous BiPAP ventilation
Correct answer: Administer a low-dose opioid such as morphine
Low-dose opioids are evidence-based for relieving dyspnea and air hunger in advanced disease by reducing the ventilatory drive and perception of breathlessness.
CHPN CHPN - Certified Hospice and Palliative Nurse Non-Pain Symptom Management Questions and Answers 2
A hospice patient with advanced heart failure develops Cheyne-Stokes respirations.
What is the most appropriate nursing intervention?