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

Question 1

A hospice patient with end-stage renal failure on scheduled oral morphine develops myoclonus and increasing agitation. Which action is most appropriate?

Accepted Answer

Rotate to an alternative opioid such as hydromorphone or fentanyl

Answer

In renal failure, morphine's active metabolite morphine-6-glucuronide (M6G) accumulates and causes neuroexcitatory toxicity, including myoclonus, agitation, and seizures. Opioid rotation to hydromorphone or fentanyl, which do not produce neuroexcitatory metabolites to the same degree, is the appropriate intervention.

Question 2

When is palliative sedation considered ethically appropriate in hospice care?

Accepted Answer

When refractory symptoms cannot be controlled by other means and the patient is near the end of life

Answer

Palliative sedation is ethically indicated for refractory, intractable symptoms (such as intractable pain, dyspnea, or delirium) in imminently dying patients when all other symptom management strategies have failed. It requires informed consent and is distinct from euthanasia in both intent and mechanism.

Question 3

A family member of a dying hospice patient tells the nurse, 'I know my mother is still alive, but I already feel like I've lost her.' Which nursing response is most therapeutic?

Accepted Answer

'What you're describing is called anticipatory grief — it's a normal part of caring for someone who is dying.'

Answer

Anticipatory grief is a well-recognized, normal psychological response that begins before the actual death of a loved one. Validating and normalizing this experience is a cornerstone of family-centered hospice care and helps prevent complicated bereavement after the death occurs.

Question 4

Which non-pharmacological intervention has the strongest evidence for reducing the perception of dyspnea in palliative care patients?

Accepted Answer

Directing airflow across the patient's face using a handheld fan

Answer

Directed airflow across the face (via a handheld or bedside fan) stimulates trigeminal nerve receptors, which modulates the central perception of breathlessness. Evidence supports its effectiveness even in non-hypoxic patients. Supplemental oxygen is only beneficial when documented hypoxia is present.

Question 5

A patient with advanced cancer tells the hospice nurse, 'I don't want to talk about dying — I just want you to fix me.' Which communication approach is most appropriate?

Accepted Answer

Explore what 'getting better' means to the patient and what they are most hoping for

Answer

Using open-ended, exploratory questions (e.g., 'What does getting better look like for you?') allows the nurse to understand the patient's underlying values, hopes, and fears without forcing a confrontational conversation about dying. This patient-centered approach, grounded in motivational interviewing, builds trust and opens the door for future goals-of-care discussions.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

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