CHPN - Certified Hospice and Palliative Nurse Certified Hospice and Palliative Nurse 1 — Questions and Answers
Question 1: A hospice nurse is caring for a patient with end-stage cancer who reports pain rated 8/10 despite scheduled oral morphine. The patient is now unable to swallow. What is the most appropriate next step?
- Double the oral morphine dose and crush the tablets
- Transition to subcutaneous or intravenous opioid administration (Correct answer)
- Withhold opioids until the patient can swallow again
- Switch to acetaminophen suppositories as an alternative
Correct answer: Transition to subcutaneous or intravenous opioid administration
When a patient can no longer swallow oral medications, the route of opioid administration must be changed rather than the medication withheld. Subcutaneous or intravenous delivery maintains effective pain control and is the standard of care in hospice for patients with dysphagia.
Question 2: A family member of a dying patient insists that 'doing everything possible' means continuing IV fluids and antibiotics. Which response by the hospice nurse best addresses this request?
- Agree to restart IV fluids to support the family's wishes
- Explain that hospice rules prohibit IV fluids and antibiotics
- Explore the family's understanding of the patient's prognosis and what 'doing everything' means to them (Correct answer)
- Refer the decision entirely to the attending physician without further discussion
Correct answer: Explore the family's understanding of the patient's prognosis and what 'doing everything' means to them
Therapeutic communication that explores what the family means by 'doing everything' allows the nurse to identify underlying fears and goals. This opens a dialogue about whether the requested interventions align with the patient's comfort and values rather than dismissing or complying outright.
Question 3: Which assessment finding in a hospice patient taking long-term opioids should prompt the nurse to suspect opioid-induced neurotoxicity?
- Constipation and decreased bowel sounds
- Myoclonic jerks and vivid hallucinations (Correct answer)
- Bradycardia and hypotension
- Peripheral edema and weight gain
Correct answer: Myoclonic jerks and vivid hallucinations
Myoclonic jerks (muscle twitching) and hallucinations are hallmark signs of opioid-induced neurotoxicity, often caused by accumulation of opioid metabolites. This requires opioid rotation or dose reduction, not simply increasing the current opioid.
Question 4: A hospice nurse notices that a patient's adult children are arguing at the bedside about whether their parent would have wanted resuscitation. The patient has a valid POLST form declining CPR. What is the nurse's priority action?
- Call security to remove the arguing family members
- Remind the family that the POLST form reflects the patient's documented wishes and guide them toward honoring those wishes (Correct answer)
- Allow the family to override the POLST form since they are the legal next of kin
- Document the disagreement and take no further action
Correct answer: Remind the family that the POLST form reflects the patient's documented wishes and guide them toward honoring those wishes
A valid POLST (Physician Orders for Life-Sustaining Treatment) form legally documents the patient's advance directive. The nurse's role is to uphold patient autonomy by clearly and compassionately reminding the family that this document reflects the patient's own expressed wishes.
Question 5: A palliative care nurse is assessing a patient for total pain. Which domain is included in the concept of 'total pain' as described by Dame Cicely Saunders?
- Physical, psychological, social, and spiritual dimensions (Correct answer)
- Physical and pharmacological dimensions only
- Acute and chronic pain scales
- Nociceptive and neuropathic pain types
Correct answer: Physical, psychological, social, and spiritual dimensions
Dame Cicely Saunders introduced the concept of 'total pain' to encompass not only physical suffering but also psychological distress, social concerns, and spiritual anguish. Addressing all four dimensions is foundational to holistic hospice and palliative care.
Question 6: A hospice nurse is preparing to administer sublingual lorazepam to a patient in the final hours of life who is experiencing refractory terminal agitation. Which action is most important before administration?
- Obtain a new physician order because lorazepam cannot be used sublingually
- Verify that the medication and route are included in the patient's comfort care orders (Correct answer)
- Ask the family to leave the room before administering any sedating medication
- Check the patient's blood pressure and withhold if systolic is below 90 mmHg
Correct answer: Verify that the medication and route are included in the patient's comfort care orders
Before administering any medication, especially in the final hours of life, the nurse must confirm that the drug, dose, and route are covered under existing comfort care orders. Sublingual lorazepam is a recognized route for terminal agitation management, but verification of the order ensures safe, authorized practice.
CHPN - Certified Hospice and Palliative Nurse Certified Hospice and Palliative Nurse 1
A hospice nurse is caring for a patient with end-stage cancer who reports pain rated 8/10 despite scheduled oral morphine.
The patient is now unable to swallow.
What is the most appropriate next step?