CHPN - Certified Hospice and Palliative Nurse Certified Hospice and Palliative Nurse 1

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?

Accepted Answer

Transition to subcutaneous or intravenous opioid administration

Answer

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?

Accepted Answer

Explore the family's understanding of the patient's prognosis and what 'doing everything' means to them

Answer

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?

Accepted Answer

Myoclonic jerks and vivid hallucinations

Answer

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?

Accepted Answer

Remind the family that the POLST form reflects the patient's documented wishes and guide them toward honoring those wishes

Answer

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?

Accepted Answer

Physical, psychological, social, and spiritual dimensions

Answer

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.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Certified Hospice and Palliative Nurse 1