CHPN CHPN - Certified Hospice and Palliative Nurse Pain Management Strategies Questions and Answers 2 — Questions and Answers
Question 1: A hospice patient with advanced pancreatic cancer reports deep, poorly localized abdominal pain that is constant and aching. Which type of pain does this most likely represent?
- Visceral pain (Correct answer)
- Somatic pain
- Neuropathic pain
- Incident pain
Correct answer: Visceral pain
Deep, poorly localized, constant aching pain originating from internal organs is characteristic of visceral pain.
Question 2: Which assessment tool is most appropriate for evaluating pain in a hospice patient with advanced dementia who is nonverbal?
- PAINAD scale (Correct answer)
- Numeric Rating Scale
- Visual Analog Scale
- Brief Pain Inventory
Correct answer: PAINAD scale
The Pain Assessment in Advanced Dementia (PAINAD) scale uses behavioral observations to assess pain in nonverbal patients.
Question 3: A patient on long-term opioid therapy develops tolerance. Which clinical finding best indicates opioid tolerance rather than disease progression?
- Decreased duration of analgesia with stable disease imaging (Correct answer)
- New onset of bone pain at a previously unaffected site
- Increasing pain with documented tumor growth on imaging
- Development of allodynia in the affected limb
Correct answer: Decreased duration of analgesia with stable disease imaging
Shortened duration of analgesia despite stable disease on imaging suggests pharmacologic tolerance rather than worsening pathology.
Question 4: When rotating from oral morphine to transdermal fentanyl in a hospice patient, which principle is most important to apply?
- Use equianalgesic conversion tables and reduce the calculated dose by 25-50% for incomplete cross-tolerance (Correct answer)
- Convert at a 1:1 equianalgesic ratio without dose reduction
- Discontinue morphine immediately when the patch is applied
- Apply two patches simultaneously to prevent breakthrough pain
Correct answer: Use equianalgesic conversion tables and reduce the calculated dose by 25-50% for incomplete cross-tolerance
Equianalgesic conversion with a 25-50% dose reduction accounts for incomplete cross-tolerance and reduces overdose risk during opioid rotation.
Question 5: A hospice nurse is managing a patient with severe neuropathic pain from chemotherapy-induced peripheral neuropathy. Which medication class is considered first-line adjuvant therapy for this type of pain?
- Anticonvulsants such as gabapentin or pregabalin (Correct answer)
- Benzodiazepines such as lorazepam
- Muscle relaxants such as cyclobenzaprine
- Stimulants such as methylphenidate
Correct answer: Anticonvulsants such as gabapentin or pregabalin
Anticonvulsants like gabapentin and pregabalin are first-line adjuvant agents for neuropathic pain due to their action on calcium channels.
Question 6: Which non-pharmacological intervention has the strongest evidence for reducing pain perception in hospice patients and works by activating the gate control theory of pain?
- Transcutaneous electrical nerve stimulation (TENS) (Correct answer)
- Aromatherapy with lavender essential oil
- Music therapy sessions
- Guided imagery meditation
Correct answer: Transcutaneous electrical nerve stimulation (TENS)
TENS directly applies the gate control theory by stimulating large-diameter nerve fibers to inhibit pain signal transmission.
CHPN CHPN - Certified Hospice and Palliative Nurse Pain Management Strategies Questions and Answers 2
A hospice patient with advanced pancreatic cancer reports deep, poorly localized abdominal pain that is constant and aching.
Which type of pain does this most likely represent?