CHPN Free Hospice and Palliative Nurse Knowledge Questions and Answers 2 — Questions and Answers
Question 1: A hospice patient with end-stage COPD is experiencing increasing dyspnea despite maximum bronchodilator therapy. Which intervention is most appropriate to address refractory dyspnea?
- Low-dose oral morphine (Correct answer)
- Increase supplemental oxygen to 6 L/min
- Administer IV aminophylline
- Begin continuous nebulized albuterol
Correct answer: Low-dose oral morphine
Low-dose opioids are the gold standard for managing refractory dyspnea in palliative care by reducing the sensation of breathlessness without significantly depressing respiration.
Question 2: Which of the following best describes the concept of 'total pain' as defined by Dame Cicely Saunders?
- Pain that encompasses physical, psychological, social, and spiritual dimensions (Correct answer)
- Pain rated 10 out of 10 on the numeric rating scale
- Pain that requires multimodal pharmacologic intervention
- Pain that persists despite adequate opioid titration
Correct answer: Pain that encompasses physical, psychological, social, and spiritual dimensions
Total pain is a holistic concept recognizing that suffering includes physical, emotional, social, and spiritual components that all require attention.
Question 3: A palliative care nurse notices mottling on a patient's lower extremities, decreased urine output, and Cheyne-Stokes respirations. What phase of dying do these signs most likely indicate?
- Active dying phase (Correct answer)
- Transitional phase
- Stable decline phase
- Crisis phase
Correct answer: Active dying phase
Mottling, oliguria, and Cheyne-Stokes respirations are classic signs of the active dying phase indicating death is likely within hours to days.
Question 4: Which medication is most appropriate for managing terminal secretions (death rattle) in an actively dying hospice patient?
- Glycopyrrolate (Correct answer)
- Furosemide
- Ipratropium bromide inhaler
- Normal saline nebulizer
Correct answer: Glycopyrrolate
Glycopyrrolate is an anticholinergic that reduces secretion production without crossing the blood-brain barrier, making it ideal for managing death rattle.
Question 5: A family member asks the hospice nurse why their loved one has stopped eating and drinking. Which response best reflects palliative care principles?
- Decreased appetite is a natural part of the dying process and forcing intake can cause discomfort (Correct answer)
- The patient needs a feeding tube to prevent malnutrition
- IV fluids should be started to prevent dehydration
- Appetite stimulants should be prescribed immediately
Correct answer: Decreased appetite is a natural part of the dying process and forcing intake can cause discomfort
Anorexia and decreased fluid intake are normal physiological changes in the dying process, and artificial nutrition can increase discomfort through fluid overload and aspiration risk.
Question 6: According to the Medicare Hospice Benefit, what is the primary eligibility criterion for a patient to receive hospice services?
- 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
- The patient must be bedridden and unable to perform any activities of daily living
- The patient must have failed all curative treatment options
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.
CHPN Free Hospice and Palliative Nurse Knowledge Questions and Answers 2
A hospice patient with end-stage COPD is experiencing increasing dyspnea despite maximum bronchodilator therapy.
Which intervention is most appropriate to address refractory dyspnea?