CHPN® Exam (Certified Hospice and Palliative Nurse) — Questions and Answers

Question 1: A hospice patient with a valid Physician Orders for Life-Sustaining Treatment (POLST) form indicating "Do Not Hospitalize" develops a fever and urinary symptoms. The patient's distressed adult child demands the patient be sent to the emergency room. What is the CHPN's primary advocacy role in this situation?

Tell the family that their request goes against the patient's legal document and cannot be honored.
Gently reorient the family to the patient's stated wishes on the POLST form and explore their underlying fears. (Correct answer)
Call 911 immediately to transport the patient as the family requested.
Contact the on-call physician to request an order to override the POLST due to family distress.

Correct answer: Gently reorient the family to the patient's stated wishes on the POLST form and explore their underlying fears.

The nurse's primary role as an advocate is to uphold the patient's documented wishes as stated in the POLST, which is a medical order. This involves therapeutically communicating these wishes to the family, exploring the reasons for their request (which often stem from fear or guilt), and providing education and support to align care with the patient's goals. Simply refusing or immediately calling 911 fails to address the family's emotional needs and the core principles of patient advocacy.

Question 2: Palliative sedation for refractory suffering is ethically justified under which doctrine?

Principle of Utility
Substituted Judgment Standard
Rule of Rescue
Doctrine of Double Effect (Correct answer)

Correct answer: Doctrine of Double Effect

The Doctrine of Double Effect holds that an action intended to relieve suffering (sedation) is ethically permissible even if it may foreseeably hasten death as an unintended secondary effect.

Question 3: Which of the following is a key component of a Goals of Care conversation in palliative nursing?

Eliciting the patient's values, fears, and understanding of their illness (Correct answer)
Deferring all conversations to the attending physician
Presenting only the treatment options the team recommends
Focusing exclusively on DNR/DNI status

Correct answer: Eliciting the patient's values, fears, and understanding of their illness

Goals of Care conversations are patient-centered and require eliciting values, prognosis understanding, and personal fears to guide care planning.

Question 4: During an interdisciplinary group (IDG) meeting, the social worker and the chaplain express differing opinions on the primary source of a patient's existential distress, leading to a debate on the best approach for psychosocial support. Which of the following actions BEST describes the CHPN's role as the care coordinator?

Ask the medical director to make the final decision to save time.
Side with the discipline that has the longest-standing relationship with the patient.
Facilitate a collaborative discussion, seeking to integrate both perspectives into a holistic plan of care. (Correct answer)
Postpone the discussion to the next meeting to allow for tempers to cool.

Correct answer: Facilitate a collaborative discussion, seeking to integrate both perspectives into a holistic plan of care.

The CHPN's role in the IDG is often to coordinate care and facilitate collaboration. The most effective action is to foster a discussion that respects the expertise of both the social worker and chaplain, aiming to create a comprehensive plan that addresses the patient's multifaceted distress from both perspectives rather than choosing one over the other.

Question 5: A patient has chosen to enroll in a hospice program in instead of stopping dialysis. Of the symptoms listed below, which one should the nurse be ready to effectively in this patient?

Hiccoughs, pain, and arrhythmias.
Constipation, fever, and seizures.
Nausea, dry mouth, and pruitus. (Correct answer)
Hypotension, ascites, and confusion

Correct answer: Nausea, dry mouth, and pruitus.

When a patient with end-stage renal disease chooses hospice over dialysis, the cessation of dialysis will lead to a buildup of toxins and fluid. This commonly causes symptoms such as nausea (from uremia), dry mouth (due to fluid shifts and uremia), and pruritus (itching, also due to uremia). The nurse should be prepared to manage these specific symptoms effectively.

Question 6: Which of the following BEST describes the concept of 'total pain' as defined by Dame Cicely Saunders?

Pain that cannot be controlled by any pharmacologic means
Pain that affects the entire body rather than a localized site
The multidimensional suffering encompassing physical, psychological, social, and spiritual components (Correct answer)
Pain that occurs continuously without any periods of relief

Correct answer: The multidimensional suffering encompassing physical, psychological, social, and spiritual components

Saunders coined 'total pain' to describe the holistic suffering of dying patients, requiring a multidisciplinary approach addressing all dimensions.

Question 7: Which of the following best describes the concept of 'total pain' as introduced by Dame Cicely Saunders?

The interplay of physical, psychological, social, and spiritual suffering (Correct answer)
The cumulative opioid dose required to achieve comfort
Pain that does not respond to any pharmacologic intervention
The maximum pain score recorded during a patient's hospital stay

Correct answer: The interplay of physical, psychological, social, and spiritual suffering

Dame Cicely Saunders, founder of the modern hospice movement, coined 'total pain' to describe the multidimensional nature of suffering — encompassing physical symptoms alongside emotional distress, social isolation, and spiritual anguish — requiring a holistic care approach.

Question 8: Which ethical principle is MOST directly supported when a hospice team honors a patient's advance directive refusing cardiopulmonary resuscitation?

Beneficence
Non-maleficence
Justice
Autonomy (Correct answer)

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 9: A hospice nurse receives a subpoena requesting a deceased patient's complete medical record. What should the nurse do first?

Immediately provide all requested records to comply with the subpoena
Refuse to release records because the patient is deceased
Destroy any sensitive information before releasing the records
Notify the agency's legal counsel or privacy officer before releasing any records (Correct answer)

Correct answer: Notify the agency's legal counsel or privacy officer before releasing any records

Any subpoena for medical records should be directed to the agency's legal counsel or privacy officer to ensure compliance with HIPAA and applicable state laws before any records are released.

Question 10: Under HIPAA, a hospice nurse may share a patient's protected health information with the patient's family member without written authorization when:

The nurse believes sharing will benefit the family's emotional wellbeing
The patient is present, has capacity, and does not object to the disclosure (Correct answer)
The family member has power of attorney for financial matters
The family member requests it verbally and identifies themselves as next of kin

Correct answer: The patient is present, has capacity, and does not object to the disclosure

HIPAA permits sharing PHI with involved family members when the patient is present, has decision-making capacity, and does not object to the disclosure.

Question 11: Which intervention is most appropriate for a bereaved family member showing signs of complicated grief?

Encourage the family member to 'move on' and resume normal life within 6 months
Provide only written bereavement educational materials and pamphlets
Referral to a mental health professional specializing in grief therapy such as Complicated Grief Treatment (Correct answer)
Discontinue all contact since the patient has died and the hospice episode is closed

Correct answer: Referral to a mental health professional specializing in grief therapy such as Complicated Grief Treatment

Complicated grief requires specialized intervention beyond standard bereavement support; referral to a mental health professional with expertise in grief therapy is the most appropriate action.

Question 12: When advocating for a hospice patient's right to refuse treatment, the nurse should FIRST:

Ensure the patient has decision-making capacity and understands the consequences (Correct answer)
Notify the physician and document the refusal
Contact the ethics committee immediately
Ask the family to persuade the patient to accept treatment

Correct answer: Ensure the patient has decision-making capacity and understands the consequences

Before acting on a refusal, the nurse must confirm the patient has decision-making capacity and comprehends the potential outcomes.

Question 13: Which bereavement intervention is MOST appropriate immediately after the death of a hospice patient?

Waiting until the family initiates contact with the hospice team
Sending a condolence card and contacting the family within 24-72 hours (Correct answer)
Providing a list of community resources and ending contact
Scheduling a grief support group in six months

Correct answer: Sending a condolence card and contacting the family within 24-72 hours

Timely bereavement outreach within 24-72 hours after death demonstrates support and helps assess the family's immediate grief needs.

Question 14: According to Medicare hospice benefit guidelines, how often must a patient be recertified for hospice eligibility?

Every 30 days
Every 6 months
At the start of each benefit period (Correct answer)
Annually

Correct answer: At the start of each benefit period

Medicare requires recertification at the beginning of each benefit period: two 90-day periods followed by unlimited 60-day periods.

Question 15: Which non-pharmacological intervention has the strongest evidence for reducing pain perception in hospice patients?

Guided imagery and relaxation techniques (Correct answer)
Acupuncture performed by the nurse
Homeopathic remedies
Therapeutic touch

Correct answer: Guided imagery and relaxation techniques

Guided imagery and relaxation techniques have the strongest evidence base among non-pharmacological approaches for pain modulation in palliative populations.

Question 16: Which medication class is FIRST-LINE for treating nausea caused by opioid-induced constipation and gastric dysmotility in hospice patients?

Prokinetics (e.g., metoclopramide) (Correct answer)
Corticosteroids
Benzodiazepines
Antihistamines

Correct answer: Prokinetics (e.g., metoclopramide)

Prokinetic agents like metoclopramide improve gastric emptying and are first-line for opioid-related nausea and dysmotility.

Question 17: A hospice nurse is caring for a patient whose family insists on continuing aggressive IV fluids despite the patient's advance directive refusing such treatment. Which action best reflects the nurse's ethical obligation?

Defer to the family's wishes to maintain harmony
Contact the physician to order the fluids as requested by the family
Administer fluids and document family request
Advocate for the patient's stated wishes and involve the interdisciplinary team (Correct answer)

Correct answer: Advocate for the patient's stated wishes and involve the interdisciplinary team

The nurse's primary ethical obligation is to the patient's autonomy as expressed in the advance directive. Advocacy through the interdisciplinary team — which may include a social worker, chaplain, or ethics consultant — ensures the patient's wishes are honored.

Question 18: A hospice nurse discovers that a colleague has been diverting controlled substances from the medication supply. What is the nurse's most appropriate first action?

Confront the colleague privately and ask them to stop
Contact law enforcement directly
Document the observation and wait to see if it happens again
Report the concern to the nursing supervisor or compliance officer (Correct answer)

Correct answer: Report the concern to the nursing supervisor or compliance officer

Suspected drug diversion must be reported immediately through proper institutional channels, typically to a supervisor or compliance officer, to protect patient safety.

Question 19: When calculating an appropriate breakthrough opioid dose, what percentage of the total daily opioid dose should typically be used?

10-15% (Correct answer)
50%
1-5%
25-30%

Correct answer: 10-15%

Breakthrough doses are standardly calculated as 10-15% of the total daily opioid dose, administered every 1-4 hours as needed.

Question 20: A hospice nurse is providing bereavement support to a spouse who lost their partner 14 months ago. The spouse reports persistent yearning, difficulty accepting the death, and inability to engage in daily activities. Which condition should the nurse recognize?

Prolonged grief disorder (Correct answer)
Normal grief response
Post-traumatic stress disorder
Major depressive disorder

Correct answer: Prolonged grief disorder

Prolonged grief disorder is characterized by persistent, intense grief lasting beyond 12 months that significantly impairs daily functioning and includes yearning and difficulty accepting the loss.

Question 21: A hospice nurse notices signs of elder abuse during a home visit. The patient asks the nurse not to report it. What is the nurse's legal obligation?

Discuss the situation only with the patient's family members
Document the findings but defer reporting until the patient gives consent
Report the suspected abuse to the appropriate adult protective services agency as mandated by law (Correct answer)
Respect the patient's autonomy and honor the request not to report

Correct answer: Report the suspected abuse to the appropriate adult protective services agency as mandated by law

Hospice nurses are mandated reporters and are legally required to report suspected elder abuse regardless of the patient's wishes.

Question 22: A patient with terminal illness requests information about voluntary stopping of eating and drinking (VSED). The hospice nurse's most appropriate response is to:

Document the request and take no further action
Provide balanced information and refer to the interdisciplinary team for support (Correct answer)
Immediately contact the ethics committee
Refuse to discuss VSAD as it violates hospice philosophy

Correct answer: Provide balanced information and refer to the interdisciplinary team for support

VSED is a legally and ethically recognized option for dying patients; the nurse should provide information and involve the IDT to support the patient.

Question 23: A patient with lung cancer reports abruptly having severe left side pleuritic discomfort. He displays The most likely diagnosis is: ""Auscultation reveals decreased breath sounds on the left, along with dyspnea, tachypnea, tachycardia, and a slight cough.

Pneumothorax (Correct answer)
Cardiac tamponade
Atelectasis
Pneumonia

Correct answer: Pneumothorax

The patient's symptoms of abrupt severe pleuritic discomfort, dyspnea, tachypnea, tachycardia, and decreased breath sounds on the left side are classic indicators of a pneumothorax. This condition involves air accumulating in the pleural space, causing the lung to collapse. Lung cancer patients are at an increased risk due to weakened lung tissue or tumor invasion.

Question 24: A patient receiving around-the-clock morphine develops pinpoint pupils, excessive sedation, and a respiratory rate of 6 breaths per minute. What is the priority nursing intervention?

Reposition the patient to a side-lying position
Increase supplemental oxygen flow rate
Administer naloxone as prescribed (Correct answer)
Withhold the next scheduled dose and monitor

Correct answer: Administer naloxone as prescribed

Pinpoint pupils, sedation, and respiratory depression indicate opioid toxicity requiring naloxone administration to reverse the life-threatening respiratory depression.

Question 25: What is the role of the interdisciplinary team (IDT) in hospice care?

To focus exclusively on the patient's physical needs
To collaboratively develop and review the patient's plan of care (Correct answer)
To limit communication between disciplines
To make all medical decisions without family input

Correct answer: To collaboratively develop and review the patient's plan of care

The IDT collaboratively develops, reviews, and revises the plan of care to address the patient's holistic needs.

Question 26: The NURSE Act is relevant to palliative care nursing practice because it:

Provides a legal framework supporting nurses who advocate for adequate pain and symptom management (Correct answer)
Requires nurses to report physicians who under-prescribe opioids
Establishes the Medicare Hospice Benefit reimbursement structure
Mandates hospice admission for all patients with six-month prognoses

Correct answer: Provides a legal framework supporting nurses who advocate for adequate pain and symptom management

The NURSE Act (Nurses for the Understanding of Research, Science, and Education in pain management) supports nurses' advocacy for adequate pain treatment without fear of regulatory reprisal.

Question 27: Which ethical principle is most directly invoked when a hospice nurse honors a patient's documented refusal of artificial nutrition?

Justice
Autonomy (Correct answer)
Beneficence
Nonmaleficence

Correct answer: Autonomy

Respecting a competent patient's informed refusal of treatment is the core expression of the autonomy principle.

Question 28: The best course of action for bringing down a fever that is higher than 38.8° C (102° F) is:

Cold bath
Acetaminophen or ibuprofen (Correct answer)
Aspirin

Correct answer: Acetaminophen or ibuprofen

Acetaminophen or ibuprofen are antipyretics, meaning they work to reduce fever by acting on the brain's temperature-regulating center. They are considered the safest and most effective first-line treatments for fever in most cases. Cold baths can induce shivering, which paradoxically increases body temperature, and aspirin is generally avoided in children and adolescents due to the risk of Reye's syndrome.

Question 29: When a patient is diagnosed with renal cell carcinoma that has metastasized to the liver and is surgically unresectable, which of the following is prescribed?

Temsirolimus (Correct answer)
Cetuximab
Nilotinib
Fluorouracil

Correct answer: Temsirolimus

Advanced renal cell carcinoma patients are treated with temsirolimus.

Question 30: A patient with bone metastases has pain well-controlled at rest but reports severe movement-related (incident) pain. What intervention most specifically targets incident pain?

Switching to methadone
Administering a rapid-onset opioid 20-30 minutes before activity (Correct answer)
Starting a ketamine infusion
Doubling the long-acting opioid

Correct answer: Administering a rapid-onset opioid 20-30 minutes before activity

Rapid-onset opioids given prophylactically before anticipated painful activities are the standard approach to incident (movement-related) pain.

Question 31: A hospice patient develops myoclonus and increased sedation after a recent opioid dose increase. What is the most likely cause?

Uncontrolled anxiety
Drug-seeking behavior
Opioid addiction
Opioid-induced neurotoxicity from accumulation of metabolites (Correct answer)

Correct answer: Opioid-induced neurotoxicity from accumulation of metabolites

Opioid-induced neurotoxicity — often due to accumulation of active metabolites such as morphine-6-glucuronide — can cause myoclonus, sedation, and cognitive changes.

Question 32: What characterizes 'disenfranchised grief,' a concept developed by Kenneth Doka?

Grief that is excessively prolonged beyond socially accepted timeframes
Grief limited to immediate family members and not extended to friends or coworkers
Grief experienced specifically after a death by suicide
Grief that is not openly acknowledged, publicly mourned, or socially supported because the loss is not recognized as significant by others (Correct answer)

Correct answer: Grief that is not openly acknowledged, publicly mourned, or socially supported because the loss is not recognized as significant by others

Disenfranchised grief refers to grief that lacks social recognition and support because the relationship or the loss itself is not acknowledged as worthy of mourning by the surrounding community.

Question 33: What is the MOST important factor the nurse should assess before beginning patient education?

Whether the physician has ordered education
Whether the patient has insurance coverage for educational materials
The patient's current level of pain, anxiety, and readiness to learn (Correct answer)
The time available before the nurse's next visit

Correct answer: The patient's current level of pain, anxiety, and readiness to learn

Pain, anxiety, and readiness to learn must be assessed first because uncontrolled symptoms significantly impair the patient's ability to retain new information.

Question 34: When is palliative sedation considered ethically appropriate in hospice care?

When refractory symptoms cannot be controlled by other means and the patient is near the end of life (Correct answer)
As a first-line treatment for existential or spiritual distress
Only when the patient has a DNR and no active advance directive disputes exist
When any patient requests it due to fear of future suffering

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

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 35: Which of the following is a key component of providing culturally competent end-of-life care?

Assessing each patient's and family's individual cultural beliefs and preferences about death and dying (Correct answer)
Applying standardized cultural protocols based on the patient's ethnicity
Deferring all care decisions to the oldest male family member
Avoiding discussions about death to prevent cultural offense

Correct answer: Assessing each patient's and family's individual cultural beliefs and preferences about death and dying

Culturally competent care requires individualized assessment of beliefs and preferences rather than applying stereotypical assumptions based on ethnicity or background.

Question 36: Which ethical principle is MOST directly applied when a competent patient refuses a blood transfusion based on religious beliefs?

Autonomy (Correct answer)
Nonmaleficence
Justice
Beneficence

Correct answer: Autonomy

Autonomy grants competent individuals the right to make their own healthcare decisions, including refusal of life-sustaining treatment for religious or personal reasons.

Question 37: A dying patient is unable to swallow and has moderate pain. The family refuses an IV line. Which route is most appropriate for opioid delivery?

Holding opioids until IV access established
Sublingual or buccal administration (Correct answer)
Intramuscular injection
Rectal suppository only

Correct answer: Sublingual or buccal administration

Sublingual or buccal opioid administration is a noninvasive, effective alternative when the patient cannot swallow and IV access is unavailable.

Question 38: In bereavement care, what is the recommended minimum duration of follow-up that hospice programs must offer to bereaved family members under the Medicare Conditions of Participation?

6 months
30 days
24 months
13 months (Correct answer)

Correct answer: 13 months

Medicare CoPs require hospices to offer bereavement services to the family for at least 13 months following the patient's death.

Question 39: A hospice patient with advanced pancreatic cancer reports deep, poorly localized abdominal pain that is constant and aching. Which type of pain does this most likely represent?

Neuropathic pain
Somatic pain
Visceral pain (Correct answer)
Incident pain

Correct answer: Visceral pain

Deep, poorly localized, constant aching pain originating from internal organs is characteristic of visceral pain.

Question 40: According to Worden's tasks of mourning, which task involves accepting the reality of the loss?

Task I — Accepting the reality of the loss (Correct answer)
Task II — Processing the pain of grief
Task IV — Finding an enduring connection with the deceased
Task III — Adjusting to a world without the deceased

Correct answer: Task I — Accepting the reality of the loss

Task I in Worden's model is 'Accept the Reality of the Loss,' involving intellectual and emotional acknowledgment that the person is dead and will not return.

Question 41: A palliative nurse recognizes that a patient's pain report is inconsistent with their behavioral cues. What is the gold standard for pain assessment in cognitively intact patients?

Physiological signs such as heart rate
Patient self-report (Correct answer)
Caregiver report
Behavioral observation scale

Correct answer: Patient self-report

Patient self-report is always the gold standard for pain assessment in patients who can communicate, regardless of discrepant behavioral cues.

Question 42: A palliative nurse assesses a patient's opioid regimen. The patient uses 240 mg of oral morphine daily with four breakthrough doses of 40 mg each used consistently. What does this pattern indicate?

The patient is exhibiting drug-seeking behavior
The patient's pain is well-controlled and no change is needed
Breakthrough dosing is excessive and should be reduced
The current basal dose is insufficient and requires titration upward (Correct answer)

Correct answer: The current basal dose is insufficient and requires titration upward

Consistent use of more than two to three breakthrough doses per day indicates the around-the-clock (basal) dose is inadequate and should be increased accordingly.

Question 43: Which adverse effect of opioids does NOT develop tolerance over time and requires ongoing management throughout therapy?

Sedation
Nausea
Respiratory depression
Constipation (Correct answer)

Correct answer: Constipation

Unlike sedation, nausea, and respiratory depression, opioid-induced constipation does not resolve with tolerance and requires consistent prophylactic bowel management.

Question 44: A patient asks the nurse, 'How long do I have to live?' Which response BEST reflects skilled end-of-life communication?

'Try not to think about that and focus on today.'
'What makes you ask that question right now? What are you hoping to understand?' (Correct answer)
'Your doctor will have to answer that question, not me.'
'Most patients in your situation live about two weeks.'

Correct answer: 'What makes you ask that question right now? What are you hoping to understand?'

Exploring the patient's underlying concern opens a therapeutic dialogue and addresses emotional needs before providing prognostic information.

Question 45: According to the Medicare Hospice Benefit, what is the primary eligibility criterion for a patient to receive hospice services?

The patient must be bedridden and unable to perform any activities of daily living
The patient must have failed all curative treatment options
A physician certifies the patient has a life expectancy of six months or less if the disease runs its normal course (Correct answer)
The patient must have a do-not-resuscitate order in place

Correct answer: A physician certifies the patient has a life expectancy of six months or less if the disease runs its normal course

Medicare hospice eligibility requires physician certification of a prognosis of six months or less if the terminal illness follows its expected trajectory.

Question 46: A patient states they want to die at home but their adult children disagree. The nurse's PRIMARY role is to:

Support the family's decision to ensure caregiver safety
Defer the decision to the attending physician
Advocate for the patient's expressed preference while facilitating family communication (Correct answer)
Remain neutral and document both perspectives

Correct answer: Advocate for the patient's expressed preference while facilitating family communication

Nurses are patient advocates; the patient's autonomous wish to die at home should be supported while helping the family understand and process their concerns.

Question 47: A hospice patient with advanced COPD reports severe air hunger despite being on low-flow oxygen. Which intervention is MOST effective for relieving dyspnea in this patient?

Increase oxygen flow to 6 L/min
Apply a nonrebreather mask
Start a nebulized bronchodilator every hour
Administer low-dose oral morphine (Correct answer)

Correct answer: Administer low-dose oral morphine

Low-dose opioids such as morphine are the most evidence-based pharmacologic treatment for refractory dyspnea in palliative patients.

Question 48: A hospice patient with advanced heart failure develops Cheyne-Stokes respirations. What is the most appropriate nursing intervention?

Administer supplemental oxygen at high flow
Position the patient for comfort and educate the family that this is a normal end-of-life pattern (Correct answer)
Administer a bronchodilator nebulizer treatment
Suction the airway every 15 minutes

Correct answer: Position the patient for comfort and educate the family that this is a normal end-of-life pattern

Cheyne-Stokes respirations are a common end-of-life breathing pattern, and the priority is comfort positioning and family education rather than aggressive interventions.

Question 49: Which action by the hospice nurse BEST demonstrates advocacy at the systems level?

Documenting all patient interactions thoroughly
Administering medications correctly per policy
Reporting medication errors through proper channels
Participating in policy review to improve access to palliative sedation for refractory symptoms (Correct answer)

Correct answer: Participating in policy review to improve access to palliative sedation for refractory symptoms

Systems-level advocacy involves influencing policies and practices that affect patient populations, not just individual patient care actions.

Question 50: Under the Medicare Hospice Benefit, which level of care is provided in a hospice facility or hospital for short-term pain and symptom management?

General inpatient care (GIP) (Correct answer)
Respite care
Routine home care
Continuous home care

Correct answer: General inpatient care (GIP)

General inpatient care (GIP) is provided in a facility when symptoms cannot be managed in the home setting.

Question 51: A palliative nurse is preparing to titrate opioids in an opioid-naive patient with severe cancer pain. What is the standard starting oral morphine dose for adults?

50 mg every 4 hours
20 mg every 4 hours
0.5 mg every 4 hours
5 mg every 4 hours (Correct answer)

Correct answer: 5 mg every 4 hours

The standard starting dose of oral immediate-release morphine in opioid-naive adults is 5 mg every 4 hours, titrated based on response.

Question 52: A patient with end-stage liver disease develops ascites causing significant abdominal distension and dyspnea. What non-pharmacological intervention may provide the most relief?

Elevating the foot of the bed
Applying abdominal binders tightly
Therapeutic paracentesis (Correct answer)
Restricting all oral fluids

Correct answer: Therapeutic paracentesis

Therapeutic paracentesis directly removes accumulated fluid from the peritoneal cavity, providing immediate relief of pressure-related symptoms.

Question 53: Which equianalgesic conversion is correct when rotating from oral morphine 60 mg/day to oral oxycodone?

60 mg oxycodone/day
40 mg oxycodone/day (Correct answer)
30 mg oxycodone/day
90 mg oxycodone/day

Correct answer: 40 mg oxycodone/day

The standard equianalgesic ratio of oral morphine to oral oxycodone is approximately 1.5:1, so 60 mg morphine converts to roughly 40 mg oxycodone per day.

Question 54: According to CMS Conditions of Participation, Medicare-certified hospice programs must provide bereavement services for at least how long following a patient's death?

3 months
6 months
13 months (Correct answer)
24 months

Correct answer: 13 months

CMS Conditions of Participation (42 CFR 418.88) require Medicare-certified hospice programs to provide bereavement services for at least 13 months following the death of a hospice patient.

Question 55: Which opioid is generally considered the safest choice for a hospice patient with renal impairment requiring pain management?

Morphine
Meperidine
Codeine
Hydromorphone (Correct answer)

Correct answer: Hydromorphone

Hydromorphone is preferred in renal impairment because it produces fewer neurotoxic active metabolites compared to morphine, codeine, or meperidine.

Question 56: What is the primary goal of the hospice interdisciplinary team (IDT) meeting?

Determine billing codes for the visit period
Assign nursing tasks to each team member
Review and update the patient's plan of care collaboratively (Correct answer)
Evaluate whether the patient still qualifies for the hospice benefit

Correct answer: Review and update the patient's plan of care collaboratively

The IDT meeting exists to collaboratively review and update the individualized plan of care, ensuring all disciplines — nursing, social work, chaplaincy, and medicine — address the patient's physical, psychosocial, and spiritual needs in a coordinated way.

Question 57: When attending to a patient's spiritual needs, which of the following is imperative?

Obtaining permission to contact the patient's clergy.
Being available to pray with the patient.
Sharing ones own spiritual beliefs with the patient.
Discerning when physical symptoms are indicative of spiritual concerns. (Correct answer)

Correct answer: Discerning when physical symptoms are indicative of spiritual concerns.

When addressing a patient's spiritual needs, it is imperative for the nurse to recognize that spiritual distress can manifest as physical symptoms or exacerbate existing ones. By discerning when physical complaints might have underlying spiritual roots, the nurse can provide holistic care that addresses the patient's comprehensive well-being, rather than solely focusing on physical aspects.

Question 58: Which document is most important for a nurse to review when determining a patient's resuscitation preferences in the home hospice setting?

The out-of-hospital DNR or POLST/MOLST form (Correct answer)
The hospice admission paperwork
The attending physician's verbal instructions
The family's written letter of preferences

Correct answer: The out-of-hospital DNR or POLST/MOLST form

An out-of-hospital DNR or POLST/MOLST is the legally recognized document that guides EMS and home care providers.

Question 59: When conducting a bereavement risk assessment, which family member would be considered HIGHEST risk for complicated grief?

A 45-year-old who lost a parent to cancer after two years of illness and has a supportive spouse
A 70-year-old with a close-knit religious community whose sibling died peacefully in an inpatient hospice
A 65-year-old widow with strong family support whose husband died after a year-long illness with good symptom control
A 30-year-old with no social support whose spouse died suddenly and who has a prior history of depression (Correct answer)

Correct answer: A 30-year-old with no social support whose spouse died suddenly and who has a prior history of depression

The highest risk profile combines young age, sudden death, absence of social support, and prior mental health history — all present in the 30-year-old with no support and a history of depression.

Question 60: A palliative care patient asks about the difference between palliative sedation and euthanasia. The nurse's BEST response is:

Both intend to hasten death, differing only in method
They are ethically identical under the principle of double effect
Palliative sedation is illegal everywhere in the US
Palliative sedation aims to relieve refractory suffering, not to hasten death, while euthanasia intentionally ends life (Correct answer)

Correct answer: Palliative sedation aims to relieve refractory suffering, not to hasten death, while euthanasia intentionally ends life

Palliative sedation targets refractory symptom relief and death is not the intended outcome, distinguishing it ethically and legally from euthanasia.

Question 61: What is 'resilience' in the context of bereavement research and clinical practice?

Suppressing grief emotions in order to remain productive and functional at work
Returning to all pre-loss functioning levels within two weeks of the death
The ability to maintain relatively stable psychological and physical functioning while experiencing grief (Correct answer)
The complete absence of grief symptoms following a significant loss

Correct answer: The ability to maintain relatively stable psychological and physical functioning while experiencing grief

In bereavement research, resilience describes maintaining relatively stable functioning despite experiencing grief — not the absence of grief or suppression of emotions.

Question 62: Which statement indicates a family member has understood teaching about the active dying phase?

'Increased sleeping means their condition is improving.'
'I should offer small sips of water every hour to keep them hydrated.'
'Changes in breathing and mottled skin mean the end is very near.' (Correct answer)
'I should call 911 if their breathing becomes irregular.'

Correct answer: 'Changes in breathing and mottled skin mean the end is very near.'

Understanding that mottling and breathing changes are signs of imminent death, not reversible decline, is a key educational goal for families.

Question 63: A patient on opioid therapy develops severe constipation unresponsive to stimulant laxatives. Which agent specifically targets opioid-induced constipation?

Docusate sodium
Methylnaltrexone (Relistor) (Correct answer)
Lactulose
Bisacodyl suppository

Correct answer: Methylnaltrexone (Relistor)

Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that relieves opioid-induced constipation without reversing central analgesia.

Question 64: Which medication is the FIRST-LINE treatment for death rattle (noisy secretions) in the actively dying patient?

Furosemide IV
Lorazepam IV
Nebulized normal saline
Glycopyrrolate or hyoscine (scopolamine) (Correct answer)

Correct answer: Glycopyrrolate or hyoscine (scopolamine)

Anticholinergic agents like glycopyrrolate or scopolamine reduce secretion production and are first-line for death rattle.

Question 65: A bereaved spouse states they can still hear their deceased partner's voice calling their name at home. How should the nurse interpret this experience?

This is a clear sign of psychosis requiring immediate psychiatric referral and evaluation
This indicates the spouse is at high imminent risk for suicide and requires crisis intervention
This is a normal grief experience commonly reported by bereaved individuals and not indicative of psychopathology (Correct answer)
This is strong evidence of complicated grief disorder requiring specialized treatment

Correct answer: This is a normal grief experience commonly reported by bereaved individuals and not indicative of psychopathology

Transient hallucinations of hearing, seeing, or sensing the presence of the deceased are common and normal grief experiences widely documented in bereavement research, typically diminishing over time.

Question 66: What is the primary goal of a hospice bereavement support group?

To exclusively monitor participants for suicidal ideation and refer to crisis services as needed
To provide legal and financial advice about estate matters and probate following the death
To discourage discussion of the deceased in order to promote healthy forward movement
To create a shared community where bereaved individuals can process grief and reduce isolation through peer support (Correct answer)

Correct answer: To create a shared community where bereaved individuals can process grief and reduce isolation through peer support

Hospice bereavement support groups primarily aim to reduce isolation, normalize grief experiences, and foster a supportive community where bereaved individuals share with others who understand their experience.

Question 67: The term 'palliative care' is derived from the Latin word 'pallium,' which means:

Peaceful
Cloak or covering (Correct answer)
Comfort
Suffering

Correct answer: Cloak or covering

Pallium means cloak or covering, symbolizing the care that wraps around and protects patients from suffering.

Question 68: Which of the following best describes Rubin's 'two-track model of bereavement'?

The first track addresses emotional grief while the second track addresses physical health impacts
Grief proceeds on two separate tracks for spousal bereavement versus parental bereavement
Early grief follows one predictable track while later grief transitions to a different track
The bereaved simultaneously manage functional adaptation (Track I) and the ongoing relational bond with the deceased (Track II) (Correct answer)

Correct answer: The bereaved simultaneously manage functional adaptation (Track I) and the ongoing relational bond with the deceased (Track II)

Rubin's two-track model holds that bereaved individuals simultaneously navigate biopsychosocial functioning and adaptation (Track I) and their ongoing transformed relationship with the deceased (Track II).

Question 69: Which standardized tool is most appropriate for a hospice nurse to use when assessing a patient's overall symptom burden across multiple domains?

Morse Fall Scale
Glasgow Coma Scale
Karnofsky Performance Status Scale
Edmonton Symptom Assessment System (ESAS) (Correct answer)

Correct answer: Edmonton Symptom Assessment System (ESAS)

The ESAS evaluates multiple symptoms simultaneously including pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, and shortness of breath on a 0-10 scale.

Question 70: When transitioning a patient from IV morphine to oral morphine, what is the correct conversion ratio (IV to oral)?

1:2
1:3 (Correct answer)
1:6
1:1

Correct answer: 1:3

IV morphine is approximately 3 times more potent than oral morphine, so the IV-to-oral conversion ratio is 1:3.

Question 71: Which assessment tool is most appropriate for evaluating pain in a hospice patient with advanced dementia who is nonverbal?

Numeric Rating Scale
Visual Analog Scale
PAINAD scale (Correct answer)
Brief Pain Inventory

Correct answer: PAINAD scale

The Pain Assessment in Advanced Dementia (PAINAD) scale uses behavioral observations to assess pain in nonverbal patients.

Question 72: The daily maximum amount of acetaminophen is _ grams.

2 (Correct answer)
6
4
8

Correct answer: 2

The recommended maximum daily dose of acetaminophen for adults is generally 4 grams (4000 mg) for short-term use in healthy individuals. However, for long-term use, in older adults, or those with liver impairment, the recommended maximum daily dose is often reduced to 2-3 grams (2000-3000 mg) to minimize the risk of hepatotoxicity. Given the options, 2 grams is the safest and most conservative answer, especially in a general exam context where patient vulnerabilities might be implied.

Question 73: During the active dying phase, a family member is distressed by the patient's loud, gurgling respirations. Which intervention should the hospice nurse implement first?

Reposition the patient and provide oral suctioning as needed (Correct answer)
Perform deep tracheal suctioning every 30 minutes
Administer intravenous fluids to thin secretions
Increase the oxygen flow rate to 6 liters per minute

Correct answer: Reposition the patient and provide oral suctioning as needed

Repositioning to a side-lying position and gentle oral suctioning are first-line comfort measures for terminal secretions, often combined with anticholinergic medication.

Question 74: A terminally ill patient develops opioid-induced respiratory depression. Which medication reverses this effect and what is the priority nursing concern?

Neostigmine; monitor for bradycardia
Flumazenil; monitor for sedation
Physostigmine; monitor for seizures
Naloxone; administer in small titrated doses to avoid precipitating severe pain and withdrawal (Correct answer)

Correct answer: Naloxone; administer in small titrated doses to avoid precipitating severe pain and withdrawal

Naloxone reverses opioid-induced respiratory depression, but in opioid-tolerant palliative patients it must be titrated in small doses to restore breathing without precipitating acute pain crisis or withdrawal.

Question 75: When titrating subcutaneous morphine for a patient who can no longer swallow, what is the equianalgesic conversion ratio for oral to subcutaneous morphine?

2:1 (oral to subcutaneous)
3:1 (oral to subcutaneous) (Correct answer)
1:1 (oral to subcutaneous)
1:2 (oral to subcutaneous)

Correct answer: 3:1 (oral to subcutaneous)

The conversion ratio is approximately 3:1 (oral to subcutaneous), meaning the subcutaneous dose is one-third of the oral dose.

Question 76: A hospice nurse notes a patient is using breakthrough opioids every 2 hours around the clock for 3 days. What does this pattern indicate?

Opioid addiction
Drug diversion
Psychological pain
Undertreated pain requiring baseline dose adjustment (Correct answer)

Correct answer: Undertreated pain requiring baseline dose adjustment

Consistent, frequent use of breakthrough opioids indicates the baseline (scheduled) dose is inadequate and the around-the-clock regimen needs titration upward.

Question 77: What is 'complicated grief,' also referred to as prolonged grief disorder?

Persistent, intense grief reactions lasting beyond expected timeframes with significant functional impairment (Correct answer)
Grief that occurs suddenly following an unexpected traumatic death
Grief experienced simultaneously with another major stressor or loss
Grief that is kept private and not expressed publicly or socially

Correct answer: Persistent, intense grief reactions lasting beyond expected timeframes with significant functional impairment

Complicated (prolonged) grief is characterized by persistent intense mourning beyond the expected timeframe that significantly impairs the bereaved person's daily functioning.

Question 78: A patient taking fentanyl patches is switched to oral morphine. The nurse should understand that equianalgesic conversion requires:

No dose adjustment because all opioids are equivalent milligram-for-milligram
Doubling the calculated dose to prevent undertreated pain
Giving exactly the same milligram dose in the new opioid
Starting at 50% of the calculated equianalgesic dose to account for incomplete cross-tolerance (Correct answer)

Correct answer: Starting at 50% of the calculated equianalgesic dose to account for incomplete cross-tolerance

When rotating opioids, it is standard practice to reduce the calculated equianalgesic dose by 25–50% to account for incomplete cross-tolerance and individual variation.

Question 79: An IDT member from social work raises a concern that a patient's home environment is unsafe for hospice care. The nurse's role is to:

Defer entirely to social work and take no further action
Collaborate with the IDT to assess risks and develop a safe care plan (Correct answer)
Contact APS without an IDT discussion first
Discharge the patient from hospice immediately

Correct answer: Collaborate with the IDT to assess risks and develop a safe care plan

Unsafe environments require collaborative IDT problem-solving to maintain patient safety while honoring the patient's preference to remain at home.

Question 80: A patient with advanced cancer on morphine develops opioid-induced pruritus. Which intervention is MOST appropriate?

Apply topical hydrocortisone to the entire body
Administer a low-dose opioid antagonist such as nalbuphine or consider opioid rotation (Correct answer)
Start diphenhydramine scheduled around the clock
Discontinue all opioids immediately

Correct answer: Administer a low-dose opioid antagonist such as nalbuphine or consider opioid rotation

Opioid rotation can reduce pruritus by switching to an agent with less histamine release; low-dose nalbuphine (mixed agonist-antagonist) can also relieve opioid-induced itch.

Question 81: Pain due to stimulants which does not normally provoke pain is:

Hyperalgesic
Paresthesia
Allodyina (Correct answer)
Neuralgia

Correct answer: Allodyina

Allodynia is a type of neuropathic pain characterized by pain due to a stimulus that does not normally provoke pain. For example, a light touch or brushing against the skin might cause severe pain. This condition is distinct from hyperalgesia (increased pain sensitivity) or paresthesia (abnormal sensations).

Question 82: Which hospice level of care is specifically designed for a patient experiencing a short-term acute symptom crisis that cannot be managed at home?

Respite care
Continuous home care
Routine home care
General inpatient care (Correct answer)

Correct answer: General inpatient care

General inpatient care (GIP) provides short-term acute symptom management in a hospital or inpatient hospice facility.

Question 83: Which position is MOST recommended for a patient experiencing Cheyne-Stokes respirations in the final hours of life?

Supine with the head of bed flat
Trendelenburg position to increase cerebral blood flow
Prone position to maximize lung expansion
Semi-Fowler's or lateral position to improve comfort and reduce secretions (Correct answer)

Correct answer: Semi-Fowler's or lateral position to improve comfort and reduce secretions

Semi-Fowler's or a lateral position promotes comfort, facilitates drainage of secretions, and can reduce the distress of irregular breathing patterns near death.

Question 84: What other medications must to be taken along with any opioid regimen?

Diphenhydramine
Pamidronate
Senna (Correct answer)
Ondansetron

Correct answer: Senna

Any patient using an opioid should also be prescribed a prophylactic bowel regimen to avoid or treat constipation, as it is one of the major side effects of opioid therapy. Senna is a laxative stimulant that increases bowel movement by chemically stimulating the gut. Diphenhydramine is an antihistamine used to treat opioid-induced pruritus, ondansetron HCl is a 5-HT3 receptor antagonist used to prevent nausea and vomiting, and pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain.

Question 85: Which ethical principle is most directly applied when a patient with decision-making capacity refuses a recommended comfort intervention?

Autonomy (Correct answer)
Beneficence
Nonmaleficence
Justice

Correct answer: Autonomy

Autonomy grants competent patients the right to accept or refuse any treatment or intervention.

Question 86: Corticosteroids such as dexamethasone are used as adjuvant analgesics in palliative care primarily for which type of pain?

Pain from cord compression and bone metastases with inflammatory component (Correct answer)
Phantom limb pain
Colic-type visceral pain
Neuropathic burning pain

Correct answer: Pain from cord compression and bone metastases with inflammatory component

Dexamethasone reduces peritumoral edema and inflammation, making it effective for pain from spinal cord compression and bone metastases.

Question 87: When developing a plan of care for a hospice patient from a cultural background that values family decision-making over individual autonomy, the nurse should first:

Document that the patient lacks decision-making capacity
Follow the family's directives without consulting the patient
Insist on speaking privately with the patient to confirm their wishes
Assess the patient's preferred level of involvement in decision-making (Correct answer)

Correct answer: Assess the patient's preferred level of involvement in decision-making

Assessing the patient's preferred level of involvement respects both cultural values and individual autonomy by letting the patient define how decisions should be made.

Question 88: A patient who was previously taking 300 mg of extended-release phenytoin. The oral capsule used before bed is being switched to phenytoin, Which of the following is required right now?

Decreasing the dose of phenytoin
Changing the dosing interval of phenytoin (Correct answer)
Increasing the dose of phenytoin
Adding a corticosteroid

Correct answer: Changing the dosing interval of phenytoin

Phenytoin is an anticonvulsant with a narrow therapeutic index and complex pharmacokinetics. Switching from an extended-release formulation, typically taken once daily, to a standard oral capsule formulation requires careful adjustment of the dosing interval. Standard phenytoin capsules usually need to be administered more frequently (e.g., two or three times a day) to maintain stable therapeutic levels, unlike the extended-release version.

Question 89: A hospice nurse documents that patient education was 'verbalized understanding.' This documentation is considered:

Insufficient because it does not demonstrate comprehension (Correct answer)
Required by The Joint Commission standards
Best practice for proving teaching effectiveness
Adequate if the patient nodded during teaching

Correct answer: Insufficient because it does not demonstrate comprehension

Stating a patient 'verbalized understanding' does not demonstrate actual comprehension; documentation should reflect teach-back or return demonstration.

Question 90: When educating families about anticipatory grief, the nurse should EMPHASIZE that:

Anticipatory grief only occurs in family members with depression
Grieving before the death is normal and does not diminish love for the patient (Correct answer)
Families should suppress grief until after the patient dies
Anticipatory grief means the family will grieve less after the death

Correct answer: Grieving before the death is normal and does not diminish love for the patient

Anticipatory grief is a normal response to impending loss and does not lessen post-death grief; families need validation that it is a healthy process.

Question 91: A family member asks whether giving pain medication to a dying patient will hasten death. What is the most accurate and ethical response by the hospice nurse?

Appropriately titrated opioids to relieve pain do not hasten death and are ethically supported by the principle of double effect (Correct answer)
Pain medication should be withheld to prolong life
Yes, opioids always hasten death in high doses
We cannot give opioids near death because of legal risk

Correct answer: Appropriately titrated opioids to relieve pain do not hasten death and are ethically supported by the principle of double effect

Research consistently shows appropriately titrated opioids do not hasten death; the principle of double effect supports their use when the intent is comfort, even if some risk exists.

Question 92: A palliative care nurse documents a Karnofsky Performance Scale score of 30 for a patient. This score indicates the patient is:

Dead
Normal activity with minor signs of disease
Able to care for self but unable to do active work
Severely disabled, hospitalization indicated (Correct answer)

Correct answer: Severely disabled, hospitalization indicated

A Karnofsky score of 30 indicates severe disability, unable to care for self, requiring hospitalization or equivalent institutional care.

Question 93: Which statement best describes the difference between 'grief' and 'bereavement'?

Bereavement occurs before death during caregiving; grief only begins after the patient has died
Grief is always pathological in nature; bereavement describes the normal adjustment process
Bereavement is the state of having experienced a loss; grief is the emotional, cognitive, and behavioral response to that loss (Correct answer)
Grief refers to the death event itself; bereavement refers to the emotional response that follows

Correct answer: Bereavement is the state of having experienced a loss; grief is the emotional, cognitive, and behavioral response to that loss

Bereavement is the objective state of having experienced a loss through death, while grief encompasses the subjective emotional, cognitive, physical, and behavioral responses to that bereavement.

Question 94: A patient with advanced heart failure reports persistent, bothersome nausea without vomiting. The patient describes a constant feeling of fullness and bloating. Which prokinetic agent would be a logical choice to manage these specific symptoms?

Lorazepam
Ondansetron
Metoclopramide (Correct answer)
Scopolamine

Correct answer: Metoclopramide

Metoclopramide is a prokinetic agent that enhances gastrointestinal motility and gastric emptying. It is effective for nausea associated with symptoms of gastric stasis, such as bloating and early satiety, which are common in patients with advanced illness. Ondansetron is a serotonin 5-HT3 antagonist, more effective for chemotherapy- or radiation-induced nausea. Scopolamine is an anticholinergic used for motion sickness or bowel obstruction. Lorazepam is an anxiolytic that can help with anticipatory nausea.

Question 95: Which researchers proposed the 'continuing bonds' theory of grief, challenging the idea that bereaved individuals must 'let go' of the deceased?

Klass, Silverman, and Nickman (Correct answer)
Worden and Parkes
Rando and Stroebe
Kübler-Ross and Ross

Correct answer: Klass, Silverman, and Nickman

Klass, Silverman, and Nickman proposed the continuing bonds theory in 1996, suggesting that maintaining an ongoing connection with the deceased is normal and healthy rather than something to overcome.

Question 96: A patient receiving intrathecal opioid therapy for refractory pain reports sudden severe headache. What serious complication should the nurse suspect first?

Opioid toxicity
Post-dural puncture headache or catheter migration (Correct answer)
Opioid withdrawal
Rebound pain

Correct answer: Post-dural puncture headache or catheter migration

Sudden severe headache in an intrathecal catheter patient suggests post-dural puncture headache or catheter migration, requiring immediate assessment.

Question 97: A hospice nurse participates in a research study reviewing de-identified patient outcomes. Which ethical principle primarily governs this activity?

Respect for persons and beneficence under research ethics guidelines (Correct answer)
Justice
Veracity
Fidelity

Correct answer: Respect for persons and beneficence under research ethics guidelines

Human subjects research is governed by the principles of respect for persons, beneficence, and justice as outlined in the Belmont Report.

Question 98: A palliative nurse notes a patient's pain worsens significantly at night. Which factor should be assessed first?

Staff incompetence on night shift
Reduced distraction, increased anxiety, and circadian variation in pain thresholds (Correct answer)
Incorrect pain scale use at night
Malingering for additional opioids

Correct answer: Reduced distraction, increased anxiety, and circadian variation in pain thresholds

Nocturnal pain worsening is often multifactorial: fewer distractions amplify pain perception, anxiety peaks at night, and some pain types have circadian patterns.

Question 99: A hospice nurse is managing a patient with severe neuropathic pain from chemotherapy-induced peripheral neuropathy. Which medication class is considered first-line adjuvant therapy for this type of pain?

Muscle relaxants such as cyclobenzaprine
Stimulants such as methylphenidate
Anticonvulsants such as gabapentin or pregabalin (Correct answer)
Benzodiazepines such as lorazepam

Correct answer: Anticonvulsants such as gabapentin or pregabalin

Anticonvulsants like gabapentin and pregabalin are first-line adjuvant agents for neuropathic pain due to their action on calcium channels.

Question 100: A patient with advanced COPD on hospice is experiencing severe anxiety and air hunger despite maximal bronchodilator therapy. What is the most appropriate next pharmacological intervention?

Start an SSRI antidepressant for anxiety
Initiate continuous BiPAP ventilation
Administer a low-dose opioid such as morphine (Correct answer)
Increase the bronchodilator frequency to every 2 hours

Correct answer: Administer a low-dose opioid such as morphine

Low-dose opioids are evidence-based for relieving dyspnea and air hunger in advanced disease by reducing the ventilatory drive and perception of breathlessness.

Question 101: A hospice patient on long-acting morphine reports breakthrough pain occurring 5-6 times per day. What is the most appropriate intervention?

Switch to a different opioid class
Add an adjuvant analgesic only
Discontinue the long-acting opioid
Increase the long-acting opioid dose (Correct answer)

Correct answer: Increase the long-acting opioid dose

Frequent breakthrough pain (more than 3-4 episodes/day) indicates the baseline long-acting opioid dose is inadequate and should be increased.

Question 102: Which of the following best describes the ethical principle of double effect as it applies to palliative care nursing?

Allowing patients to self-administer lethal doses of medication to end suffering
Withholding treatment to hasten the patient's death when suffering is uncontrollable
Administering an intervention whose primary intent is to relieve suffering, even if a secondary effect may shorten life (Correct answer)
Providing treatments only when benefit clearly outweighs all potential harm

Correct answer: Administering an intervention whose primary intent is to relieve suffering, even if a secondary effect may shorten life

The principle of double effect holds that an action intended to achieve a good outcome (e.g., pain or dyspnea relief with opioids) is ethically permissible even if a foreseeable but unintended secondary effect could potentially shorten life. The intent distinguishes this from euthanasia. This principle underpins the ethical use of adequate opioid dosing in end-of-life care and is widely accepted in hospice and palliative nursing practice.

Question 103: Which description best defines 'total pain' as conceptualized in palliative care?

The highest numeric pain score recorded during a shift
The multidimensional experience encompassing physical, psychological, social, and spiritual suffering (Correct answer)
Pain unresponsive to all pharmacologic interventions
Pain that requires more than two opioids to control

Correct answer: The multidimensional experience encompassing physical, psychological, social, and spiritual suffering

Dame Cicely Saunders' concept of 'total pain' recognizes that suffering in dying patients is multidimensional, requiring holistic assessment and intervention across all domains.

Question 104: A hospice nurse is educating a family about the dying process. Which sign should the nurse explain as indicating death is likely within hours to days?

Bradypnea with regular rhythm and strong pulse
Increased urine output and restlessness
Increased appetite and thirst
Mottling of the extremities and Cheyne-Stokes respirations (Correct answer)

Correct answer: Mottling of the extremities and Cheyne-Stokes respirations

Mottling of the extremities and Cheyne-Stokes respirations are late signs indicating imminent death, typically within hours to days.

Question 105: A hospice nurse uses the Edmonton Symptom Assessment System (ESAS). Which symptom domain does ESAS NOT directly measure?

Spiritual distress (Correct answer)
Shortness of breath
Anxiety
Pain

Correct answer: Spiritual distress

ESAS measures physical and psychological symptoms (pain, dyspnea, nausea, depression, anxiety, drowsiness, appetite, wellbeing, tiredness) but does not directly measure spiritual distress.

Question 106: Under the Medicare Hospice Benefit, which of the following services must be provided as needed, 24 hours a day, 7 days a week?

Continuous nursing care at the bedside
Weekly chaplain visits for spiritual support
On-call telephone access to a nurse or physician (Correct answer)
Daily aide visits for personal care

Correct answer: On-call telephone access to a nurse or physician

Medicare requires hospice programs to provide around-the-clock telephone access to a nurse or other qualified professional to address patient and family needs.

Question 107: Which of the following is a recognized risk factor for developing complicated grief?

History of prior losses, trauma, or pre-existing mental health disorders (Correct answer)
Death occurring in an inpatient hospice setting with professional support
Strong and consistent social support network
A prolonged illness allowing time to prepare for the death

Correct answer: History of prior losses, trauma, or pre-existing mental health disorders

Previous losses, trauma history, and pre-existing mental health disorders are established risk factors for complicated grief, as they increase vulnerability in the bereaved.

Question 108: A hospice patient with advanced heart failure has a left ventricular assist device (LVAD). The patient and family decide to discontinue the device. What is the hospice nurse's priority action?

Ensure the interdisciplinary team has documented the informed consent discussion and coordinate a planned deactivation (Correct answer)
Transfer the patient to an acute care facility for device removal
Refuse to participate because device deactivation is considered euthanasia
Immediately deactivate the device at the bedside without further consultation

Correct answer: Ensure the interdisciplinary team has documented the informed consent discussion and coordinate a planned deactivation

LVAD deactivation requires documented informed consent, interdisciplinary coordination, and a planned approach with symptom management protocols in place.

Question 109: 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?

Replace opioid analgesia during the final hours
Induce unconsciousness to reduce the family's distress
Reduce agitation and perceptual disturbances to improve patient comfort (Correct answer)
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 110: A terminally ill patient is experiencing agitated delirium with hallucinations and combativeness. Which medication is FIRST-LINE for managing hyperactive delirium in hospice?

Diphenhydramine (antihistamine)
Haloperidol (antipsychotic) (Correct answer)
Lorazepam (benzodiazepine)
Morphine (opioid)

Correct answer: Haloperidol (antipsychotic)

Haloperidol is the first-line agent for hyperactive delirium in palliative care due to its efficacy in reducing psychotic symptoms with minimal sedation.

Question 111: What is the primary purpose of bereavement follow-up after a patient's death in hospice care?

To provide emotional support and identify those at risk for complicated grief (Correct answer)
To collect feedback about the quality of hospice services received
To ensure all legal documentation has been properly completed
To assess the family's financial needs after the death

Correct answer: To provide emotional support and identify those at risk for complicated grief

Bereavement follow-up aims to provide emotional support to the bereaved family and identify individuals at risk for complicated or prolonged grief requiring additional intervention.

Question 112: Which of the following is NOT considered a normal grief reaction?

Difficulty concentrating and short-term memory problems
Transient hallucinations of seeing or hearing the deceased
Persistent psychosis lasting more than 6 months after the death (Correct answer)
Fatigue, sleep disturbances, and changes in appetite

Correct answer: Persistent psychosis lasting more than 6 months after the death

Persistent psychosis lasting more than 6 months is not a normal grief reaction and warrants psychiatric evaluation, whereas brief hallucinations, cognitive difficulties, and fatigue are common normal grief manifestations.

Question 113: Which of the following best describes the principle of double effect in palliative care?

Withholding treatment to hasten death is ethically acceptable
Administering two medications simultaneously to improve symptom control
Providing equal doses of opioid and benzodiazepine for comfort
An action intended to relieve suffering may be justified even if it has a foreseen but unintended harmful effect (Correct answer)

Correct answer: An action intended to relieve suffering may be justified even if it has a foreseen but unintended harmful effect

The principle of double effect holds that an action intended to produce a good effect is ethically permissible even if a harmful side effect is foreseen but unintended.

Question 114: Which tool is most appropriate for assessing pain in a hospice patient with advanced dementia who cannot verbalize?

PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Visual Analog Scale (VAS)
Numeric Rating Scale (NRS)
McGill Pain Questionnaire

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale uses behavioral observation (breathing, vocalization, facial expression, body language, consolability) to assess pain in nonverbal dementia patients.

Question 115: A hospice nurse is preparing a patient for discharge to home. Which teaching is MOST critical for the family managing opioid medications?

Opioids should be kept at room temperature on the kitchen counter for easy access
Store opioids in a locked location away from children and visitors (Correct answer)
Opioids may be shared with other family members if needed
Flush unused opioids down the toilet after the patient's death

Correct answer: Store opioids in a locked location away from children and visitors

Opioid medications must be stored securely in a locked location to prevent accidental ingestion by children or diversion by visitors.

Question 116: A hospice nurse is caring for a patient whose family insists on continuing aggressive IV fluid resuscitation despite the patient's advance directive declining such measures. What should the nurse do FIRST?

Comply with the family's request immediately
Review the advance directive with the family and explain the patient's documented wishes (Correct answer)
Contact law enforcement to enforce the directive
Discontinue all care until the conflict is resolved

Correct answer: Review the advance directive with the family and explain the patient's documented wishes

The nurse should first educate the family about the patient's advance directive and facilitate understanding before escalating to other team members.

Question 117: A hospice nurse notices a patient with end-stage dementia is grimacing and resistive to care. The patient is nonverbal. Which validated tool should the nurse use to assess for distress?

Brief Pain Inventory
Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale is specifically designed for nonverbal patients with advanced dementia, using behavioral indicators like facial expression and body language.

Question 118: A patient reports their pain as burning, shooting, and electric-shock-like in quality. Which assessment finding most supports a neuropathic pain diagnosis?

Pain localized to a single point
Pain that worsens with movement
Allodynia — pain from a stimulus that does not normally cause pain (Correct answer)
Pain that responds immediately to acetaminophen

Correct answer: Allodynia — pain from a stimulus that does not normally cause pain

Allodynia (pain from non-painful stimuli such as light touch) is a hallmark feature of neuropathic pain, along with dysesthesias and hyperalgesia.

Question 119: Which patient is most likely to not receive adequate care for their pain symptoms?

86-year old female with COPD, living in an assisted living facility (Correct answer)
42-year old female with early-onset dementia, living with her sister.
74-year old male with congestive heart failure, living with his wife
51-year old male, recently diagnosed with ALS; a former weight lifter

Correct answer: 86-year old female with COPD, living in an assisted living facility

Contrary to popular belief, under-treatment of pain is more likely to occur in older people, people of color, and women than in younger individuals with fewer co-morbidities. The 86-year-old possesses two of the three risk variables for each of the four case studies.

Question 120: In hospice care, what does the concept of 'total pain' as described by Dame Cicely Saunders encompass?

Pain rated above 7 on a numeric scale
Only physical and emotional pain
Physical, psychological, social, and spiritual suffering (Correct answer)
Chronic pain lasting more than 6 months

Correct answer: Physical, psychological, social, and spiritual suffering

Dame Cicely Saunders' concept of total pain recognizes that suffering has physical, psychological, social, and spiritual dimensions that must all be addressed.

Question 121: A CHPN is providing education to a family caregiver on the safe management of liquid opioids in the home. Which instruction is a critical component of this education to prevent diversion and ensure safety?

"Keep a detailed, written log of every dose given, including the date, time, and amount." (Correct answer)
"Dispose of any small amounts of unused medication by flushing it down the toilet."
"Store the medication on the kitchen counter so you don't forget a dose."
"It is acceptable to share the medication with another family member who has severe pain."

Correct answer: "Keep a detailed, written log of every dose given, including the date, time, and amount."

Accurate and consistent documentation of controlled substance administration is a key safety measure to prevent accidental overdose, track symptom response, and identify potential diversion. Best practices for preventing diversion also include using a lockbox and performing regular pill counts, which are facilitated by a detailed log. Medication should be stored securely, not shared, and disposed of according to specific hospice policy and DEA guidelines, which may not involve flushing.

Question 122: A palliative care nurse is assessing a patient with neuropathic pain unresponsive to opioids alone. Which adjuvant is first-line for this pain type?

Gabapentin (Correct answer)
Haloperidol
Dexamethasone
Metoclopramide

Correct answer: Gabapentin

Gabapentin (and pregabalin) are first-line adjuvant analgesics for neuropathic pain in palliative care.

Question 123: A hospice patient with liver failure requires analgesic management. Which opioid dose adjustment is most appropriate?

Increase the dose due to reduced first-pass metabolism
Avoid all opioids and use NSAIDs instead
Use standard doses with no adjustment needed
Reduce the dose and extend the dosing interval (Correct answer)

Correct answer: Reduce the dose and extend the dosing interval

Hepatic failure impairs opioid metabolism, increasing drug exposure and risk of toxicity; dose reduction and extended intervals are required.

Question 124: Which factor is most associated with better bereavement outcomes for family caregivers following a hospice patient's death?

Rapid return to all normal activities within two to three weeks of the death
Strong social support and a sense of having provided good care during the illness (Correct answer)
Actively avoiding discussion of the deceased to facilitate moving forward
Complete absence of any prior relationship conflicts with the deceased

Correct answer: Strong social support and a sense of having provided good care during the illness

Adequate social support and a sense of having provided good care are protective factors associated with better bereavement outcomes, including lower rates of complicated grief and depression.

Question 125: A nurse suspects a colleague is diverting controlled substances. The most appropriate action is to:

Confront the colleague privately and warn them
Ignore the situation to avoid conflict
Document observations and report to the nurse manager or compliance officer (Correct answer)
Discuss suspicions with other staff first

Correct answer: Document observations and report to the nurse manager or compliance officer

Diversion is a patient safety and legal issue requiring immediate documentation and reporting to supervisory or compliance staff.

Question 126: A hospice nurse identifies that a patient's family speaks limited English. Which action BEST supports equitable education?

Use the patient's bilingual teenage grandchild to interpret
Arrange for a qualified professional interpreter and provide materials in the family's language (Correct answer)
Speak slowly and use gestures to communicate
Document that education was provided and move on

Correct answer: Arrange for a qualified professional interpreter and provide materials in the family's language

Professional interpreters ensure accurate communication and prevent the ethical issues that arise when minors or family members serve as interpreters.

Question 127: Which statement best describes the principle of 'opioid rotation' in palliative care?

Switching to a different opioid when analgesia is inadequate or side effects are intolerable (Correct answer)
Alternating opioids daily to prevent tolerance
Reducing the opioid dose by rotating to non-opioid drugs
Using multiple opioids simultaneously

Correct answer: Switching to a different opioid when analgesia is inadequate or side effects are intolerable

Opioid rotation involves switching to a different opioid to improve the balance between analgesia and side effects, often using incomplete cross-tolerance to achieve better control.

Question 128: A hospice patient with COPD develops increased dyspnea. After ruling out reversible causes, the MOST evidence-based pharmacologic intervention is:

High-flow oxygen for all patients
Benzodiazepines as first-line therapy
Systemic corticosteroids as monotherapy
Low-dose opioids (e.g., oral morphine 5 mg q4h) (Correct answer)

Correct answer: Low-dose opioids (e.g., oral morphine 5 mg q4h)

Low-dose opioids are the gold standard for managing refractory dyspnea in palliative care patients.

Question 129: When teaching a family about administering sublingual morphine to a non-swallowing patient, the nurse should emphasize:

Crushing the tablet and mixing with water for oral administration
Holding the dose until the patient regains the ability to swallow
Placing drops under the tongue and waiting for absorption without forcing swallowing (Correct answer)
Injecting the medication into the buccal mucosa

Correct answer: Placing drops under the tongue and waiting for absorption without forcing swallowing

Sublingual administration relies on mucosal absorption; the family must understand drops are placed under the tongue and swallowing is not required or forced.

Question 130: A hospice nurse is explaining the difference between palliative sedation and euthanasia to a family. Which statement is ACCURATE?

There is no ethical difference between the two practices
Palliative sedation relieves refractory suffering while allowing natural death; euthanasia intentionally causes death (Correct answer)
Palliative sedation is only legal in certain US states
Both are intended to hasten death

Correct answer: Palliative sedation relieves refractory suffering while allowing natural death; euthanasia intentionally causes death

Palliative sedation reduces consciousness to relieve suffering with natural death as the outcome, while euthanasia intentionally causes death — a fundamental ethical distinction.

Question 131: A hospice nurse documents a patient's prognosis using the Palliative Prognostic Score (PaP). Which variable is included in PaP calculation?

Karnofsky Performance Status and clinical prediction of survival (Correct answer)
Serum albumin level
Patient's advance directive status
Number of hospitalizations in the past year

Correct answer: Karnofsky Performance Status and clinical prediction of survival

The PaP Score incorporates clinical prediction of survival, Karnofsky Performance Status, and laboratory values (WBC, lymphocyte percentage) to estimate 30-day survival probability.

Question 132: Which of the following best describes the mechanism by which a bedside fan helps relieve dyspnea in palliative care patients?

It increases oxygen delivery to the alveoli
It lowers core body temperature, reducing oxygen demand
It humidifies inspired air, decreasing airway resistance
It stimulates trigeminal nerve receptors, reducing breathlessness perception (Correct answer)

Correct answer: It stimulates trigeminal nerve receptors, reducing breathlessness perception

Cool airflow directed at the face stimulates trigeminal receptors and reduces the central perception of breathlessness.

Question 133: A palliative care nurse educates a family about the difference between physical dependence and addiction. Which statement is correct?

Addiction always develops with long-term opioid use
Physical dependence is uncommon in hospice patients
Physical dependence is a normal physiologic response to opioids and does not indicate addiction (Correct answer)
Physical dependence means the patient is addicted

Correct answer: Physical dependence is a normal physiologic response to opioids and does not indicate addiction

Physical dependence (withdrawal if opioid is abruptly stopped) is a predictable pharmacologic response and is distinct from addiction, which involves compulsive use despite harm.

Question 134: 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
Refer the decision entirely to the attending physician without further discussion
Explore the family's understanding of the patient's prognosis and what 'doing everything' means to them (Correct answer)
Explain that hospice rules prohibit IV fluids and antibiotics

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 135: Which is the MOST common complication of long-term opioid therapy requiring prophylactic treatment in hospice patients?

Pruritus
Constipation (Correct answer)
Respiratory depression
Tolerance

Correct answer: Constipation

Unlike most opioid side effects, constipation does not diminish with time and requires scheduled laxative prophylaxis.

Question 136: What does Stroebe and Schut's 'dual process model' of grief describe?

The two phases of acute and chronic grief progression over time
The parallel processing of physical and emotional aspects of loss simultaneously
Oscillation between loss-orientation (confronting grief) and restoration-orientation (adapting to life changes) (Correct answer)
The dual caregiver and mourner roles experienced by family members

Correct answer: Oscillation between loss-orientation (confronting grief) and restoration-orientation (adapting to life changes)

Stroebe and Schut's dual process model describes how bereaved individuals naturally oscillate between loss-orientation (processing pain of the loss) and restoration-orientation (coping with secondary stressors and rebuilding life).

Question 137: When a patient lacks decision-making capacity and has no advance directive, the legal hierarchy for surrogate decision-making in most US states typically begins with:

The attending physician
The hospice social worker
A court-appointed guardian
The legal next of kin (spouse or adult children) (Correct answer)

Correct answer: The legal next of kin (spouse or adult children)

In the absence of an advance directive or durable power of attorney for health care, most US states recognize the legal next of kin—spouse, then adult children—as the default surrogate decision-maker.

Question 138: A patient with end-stage renal disease requires opioid therapy. Which opioid is SAFEST to use in this population due to its metabolite profile?

Codeine
Fentanyl (Correct answer)
Morphine
Hydromorphone

Correct answer: Fentanyl

Fentanyl is the preferred opioid in renal failure because it has inactive metabolites that do not accumulate, unlike morphine or hydromorphone.

Question 139: When educating a family about the signs and symptoms of the active dying phase, which of the following is MOST important for the CHPN to emphasize to help reduce family distress?

The likelihood that the patient will experience severe, uncontrolled pain at the very end.
That changes like mottling, altered breathing patterns, and decreased socialization are a normal part of the process. (Correct answer)
The importance of encouraging the patient to eat and drink to prevent weakness.
An exact timeline of when each specific symptom will appear.

Correct answer: That changes like mottling, altered breathing patterns, and decreased socialization are a normal part of the process.

Educating the family that common signs like Cheyne-Stokes respirations, skin mottling, and social withdrawal are expected parts of the dying process can normalize the experience and reduce fear. It reframes these signs as part of a natural process rather than as active suffering. Providing an exact timeline is impossible, forcing fluids is not recommended as needs decrease, and focusing on uncontrolled pain can increase anxiety unnecessarily.

Question 140: A bereaved family member reports feeling angry at the deceased for 'leaving them.' What is the most appropriate nursing response?

Advise the family member to avoid expressing negative feelings out of respect for the deceased
Redirect the family member to focus on positive memories of the deceased
Normalize the anger as a common grief response and provide a safe, non-judgmental space to express feelings (Correct answer)
Refer the family member to a psychiatrist immediately for anger management

Correct answer: Normalize the anger as a common grief response and provide a safe, non-judgmental space to express feelings

Anger toward the deceased is a normal grief response; the nurse should normalize these feelings and create a safe environment for expression rather than redirecting or pathologizing the emotion.

Question 141: Nearly all people with amyotrophic lateral sclerosis (ALS) in its last stages:

Exhibit signs of dementia.
Exhibit slight slurring of speech.
Have weight gain.
Require mechanical ventilation to breathe. (Correct answer)

Correct answer: Require mechanical ventilation to breathe.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that primarily affects motor neurons, leading to muscle weakness and atrophy throughout the body. In its late stages, the respiratory muscles become severely weakened, making it impossible for patients to breathe independently. Consequently, most individuals with late-stage ALS require mechanical ventilation to sustain life.

Question 142: During an interdisciplinary team (IDT) meeting, which document MOST directly guides the hospice plan of care revision?

The patient's insurance policy
The social worker's bereavement plan
The comprehensive assessment with updated symptom data and patient goals (Correct answer)
The physician's original admission orders

Correct answer: The comprehensive assessment with updated symptom data and patient goals

The comprehensive assessment, including updated symptom burden and current patient goals, is the primary evidence base for revising the interdisciplinary plan of care.

Question 143: Which educational topic is MOST important for a family caring for a hospice patient at home regarding medication safety?

How to order refills online
Proper storage, administration, and disposal of controlled substances (Correct answer)
The pharmacological mechanism of opioids
How to identify generic versus brand-name medications

Correct answer: Proper storage, administration, and disposal of controlled substances

Safe storage, correct administration, and proper disposal of controlled substances prevent diversion, accidental ingestion, and legal issues.

Question 144: Kübler-Ross's five stages of grief include all of the following EXCEPT:

Anger
Denial
Acceptance
Guilt (Correct answer)

Correct answer: Guilt

Kübler-Ross's five stages are denial, anger, bargaining, depression, and acceptance; guilt is not one of the five stages, though it is a common grief experience.

Question 145: A patient receiving parenteral nutrition at home enrolls in hospice. The hospice team should:

Immediately discontinue parenteral nutrition upon enrollment
Transfer care back to the oncologist to manage nutrition
Continue parenteral nutrition indefinitely as it is comfort-focused
Discuss with the patient and family the goals, benefits, and burdens of continued parenteral nutrition (Correct answer)

Correct answer: Discuss with the patient and family the goals, benefits, and burdens of continued parenteral nutrition

The decision to continue or discontinue parenteral nutrition in hospice requires a goals-of-care conversation weighing potential burdens against perceived benefits for that individual patient.

Question 146: Which scale is specifically designed to assess functional status and prognosis in hospice patients?

Braden Scale
Palliative Performance Scale (PPS) (Correct answer)
Glasgow Coma Scale
Morse Fall Scale

Correct answer: Palliative Performance Scale (PPS)

The Palliative Performance Scale (PPS) measures ambulation, activity, self-care, intake, and consciousness level to assess functional decline in palliative patients.

Question 147: Which medication is most commonly used to manage terminal secretions (death rattle) in hospice patients?

Dexamethasone
Furosemide
Albuterol
Glycopyrrolate (Correct answer)

Correct answer: Glycopyrrolate

Glycopyrrolate is an anticholinergic agent that reduces secretion production and is a first-line treatment for terminal secretions.

Question 148: Which theorist developed the concept of 'tasks of mourning' as an active alternative to passive stage-based grief models?

J. William Worden (Correct answer)
Elisabeth Kübler-Ross
Colin Murray Parkes
George Engel

Correct answer: J. William Worden

J. William Worden proposed the 'tasks of mourning' model, describing four active tasks mourners must work through rather than passive stages they experience.

Question 149: A nurse is managing a patient's pain with a transdermal fentanyl patch. The patient's pain acutely worsens after 60 hours. What is the most appropriate first action?

Administer an oral immediate-release opioid for breakthrough pain (Correct answer)
Assess for fever, as hyperthermia increases fentanyl absorption and may cause toxicity
Replace the patch immediately and apply a new one
Add an oral long-acting opioid

Correct answer: Administer an oral immediate-release opioid for breakthrough pain

When transdermal fentanyl does not control breakthrough or acute pain, an immediate-release opioid should be used for rescue while patch delivery continues.

Question 150: A patient with terminal cancer expresses that they feel their life has been meaningless. Which nursing intervention is most appropriate?

Offer a referral to the hospital chaplain or spiritual care provider (Correct answer)
Reassure the patient that their life had meaning without further exploration
Contact the family immediately to address the patient's concerns
Document the statement and continue with physical care

Correct answer: Offer a referral to the hospital chaplain or spiritual care provider

Referring to a chaplain or spiritual care provider addresses existential distress, which is a core component of holistic hospice care.

Question 151: A patient rates their pain 3/10 and states they are comfortable. The nurse observes mild grimacing. What is the most appropriate action?

Override the patient's report and treat as 7/10
Consult psychiatry for pain catastrophizing
Document the self-report of 3/10 as the pain score and reassess per protocol (Correct answer)
Administer breakthrough opioid based on grimacing

Correct answer: Document the self-report of 3/10 as the pain score and reassess per protocol

Self-report remains the gold standard; a patient who states they are comfortable at 3/10 should be believed and documented accordingly, with ongoing reassessment.

CHPN® Exam (Certified Hospice and Palliative Nurse)

The CHPN® exam certifies registered nurses who demonstrate expertise in providing comprehensive hospice and palliative care to patients and their families facing serious illness.

150

Questions

180 min

Time Limit

70%

To Pass

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