CHPN CHPN - Certified Hospice and Palliative Nurse Pain Management Strategies Questions and Answers 3

Question 1

A hospice patient with metastatic bone disease experiences sudden, severe pain when repositioned in bed, but reports minimal pain at rest.
What is the most accurate classification of this pain pattern?

Accepted Answer

Incident breakthrough pain

Answer

End-of-dose failure

Answer

Spontaneous breakthrough pain

Answer

Idiopathic breakthrough pain

Question 2

Which opioid is generally considered safest for hospice patients with renal impairment due to its lack of active metabolite accumulation?

Accepted Answer

Fentanyl

Answer

Morphine

Answer

Codeine

Answer

Meperidine

Question 3

A palliative care nurse notices a patient on high-dose opioids is experiencing myoclonus. Which intervention should be prioritized?

Accepted Answer

Opioid rotation to a different agent

Answer

Increasing the current opioid dose

Answer

Adding a long-acting benzodiazepine as maintenance therapy

Answer

Discontinuing all opioids immediately

Question 4

In the WHO analgesic ladder approach for cancer pain, when should a hospice nurse consider initiating a strong opioid such as morphine or hydromorphone?

Accepted Answer

When pain persists or increases despite adequate trial of Step 2 analgesics

Answer

Only after all non-pharmacological interventions have been exhausted

Answer

When the patient has a life expectancy of less than two weeks

Answer

Only when the patient specifically requests stronger medication

Question 5

A hospice patient with a history of substance use disorder requires pain management for severe cancer pain. Which approach best balances adequate analgesia with risk mitigation?

Accepted Answer

Prescribe opioids with structured monitoring, consistent dosing schedules, and involvement of the interdisciplinary team

Answer

Avoid all opioid medications and rely exclusively on non-opioid alternatives

Answer

Prescribe opioids only as needed with no structured follow-up

Answer

Defer pain management decisions entirely to the patient's addiction specialist

Question 6

Which route of opioid administration is most appropriate for a hospice patient in the active dying phase who can no longer swallow oral medications?

Accepted Answer

Sublingual or buccal

Answer

Intramuscular injection

Answer

Oral tablets crushed in water

Answer

Rectal suppositories as the only option