CHPN - Certified Hospice and Palliative Nurse Hospice and Palliative Nurse MCQ 1 — Questions and Answers
Question 1: A palliative care nurse is assessing a patient with advanced cancer who rates pain as 8/10 despite scheduled oral oxycodone. The patient is alert and able to swallow. Which action best addresses inadequate analgesia?
- Switch to a fentanyl transdermal patch immediately
- Calculate a 10–15% rescue dose of the total daily opioid and administer now (Correct answer)
- Hold the next scheduled dose and reassess in two hours
- Contact pharmacy to change the opioid to a non-opioid analgesic
Correct answer: Calculate a 10–15% rescue dose of the total daily opioid and administer now
A breakthrough (rescue) dose of 10–15% of the total 24-hour opioid dose is the standard approach for uncontrolled pain in a patient already on a scheduled opioid. This addresses the immediate pain without requiring a route change or medication switch before reassessment.
Question 2: A hospice nurse notes that a patient's breathing has changed to irregular periods of apnea alternating with rapid breaths. The family is frightened. How should the nurse explain this finding?
- This pattern indicates a treatable pulmonary embolism requiring urgent intervention
- This is Cheyne-Stokes respiration, a normal physiological change in the final hours to days of life (Correct answer)
- The patient needs immediate suctioning to clear the airway
- This breathing pattern signals uncontrolled pain and requires opioid dose escalation
Correct answer: This is Cheyne-Stokes respiration, a normal physiological change in the final hours to days of life
Cheyne-Stokes respiration results from reduced cerebral perfusion and altered carbon dioxide sensitivity as death approaches. It is an expected, non-distressing finding for the patient and does not indicate pain or a reversible condition; family education helps reduce fear.
Question 3: Which ethical principle is MOST directly supported when a hospice team honors a patient's advance directive refusing cardiopulmonary resuscitation?
- Beneficence
- Non-maleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Respecting a competently executed advance directive upholds autonomy—the patient's right to make informed decisions about their own care, including the right to refuse life-sustaining treatment. While other principles also apply, autonomy is the primary principle directly supported.
Question 4: A nurse is preparing to administer subcutaneous haloperidol to a hospice patient with terminal delirium. The patient is non-verbal and restless. What is the PRIMARY goal of this intervention?
- Induce unconsciousness to reduce the family's distress
- Reduce agitation and perceptual disturbances to improve patient comfort (Correct answer)
- Replace opioid analgesia during the final hours
- Prevent aspiration by reducing secretion production
Correct answer: Reduce agitation and perceptual disturbances to improve patient comfort
Haloperidol is a first-line antipsychotic used in terminal delirium to reduce agitation, confusion, and perceptual disturbances, improving patient comfort. It is not intended to render the patient unconscious or to replace analgesia; its goal is symptom control.
Question 5: A hospice patient's family asks why the nurse is no longer encouraging the patient to eat or drink. The patient is in the final days of life and has lost interest in food and fluids. What is the most accurate response?
- Decreased intake causes the release of ketones and endorphins that may reduce discomfort (Correct answer)
- Forcing fluids at this stage will improve circulation and extend life meaningfully
- We can start intravenous fluids to prevent dehydration-related suffering
- The patient is refusing food out of depression and should be referred to psychiatry
Correct answer: Decreased intake causes the release of ketones and endorphins that may reduce discomfort
Natural reduction in food and fluid intake at end of life is associated with ketosis and endogenous endorphin release, which can actually reduce hunger and contribute to a sense of comfort. Artificial hydration in the final days rarely extends meaningful life and may increase secretions and edema.
Question 6: A CHPN is completing a bereavement risk assessment for the family of a patient who just died. Which finding places a family member at HIGHEST risk for complicated grief?
- The deceased was over 80 years old and had been ill for two years
- The family member has strong religious beliefs and an active social support network
- The family member had a highly ambivalent or dependent relationship with the deceased (Correct answer)
- The family member lives in the same city as other relatives
Correct answer: The family member had a highly ambivalent or dependent relationship with the deceased
A pre-existing relationship characterized by ambivalence, dependency, or unresolved conflict is a well-established risk factor for complicated grief. Other protective factors include older age of the deceased, prolonged illness allowing anticipatory grieving, social support, and spiritual resources.
CHPN - Certified Hospice and Palliative Nurse Hospice and Palliative Nurse MCQ 1
A palliative care nurse is assessing a patient with advanced cancer who rates pain as 8/10 despite scheduled oral oxycodone.
The patient is alert and able to swallow.
Which action best addresses inadequate analgesia?