CHPN FREE Hospice and Palliative Nurse Questions and Answers 2 — Questions and Answers
Question 1: A hospice patient with end-stage COPD develops increasingly severe dyspnea despite maximum bronchodilator therapy. Which pharmacologic intervention is most appropriate for refractory dyspnea?
- Low-dose oral morphine (Correct answer)
- High-dose inhaled corticosteroids
- Intravenous aminophylline
- Nebulized epinephrine
Correct answer: Low-dose oral morphine
Low-dose opioids are the evidence-based first-line treatment for refractory dyspnea in terminal illness by reducing the central perception of breathlessness.
Question 2: Which assessment tool is specifically validated for measuring pain in nonverbal or cognitively impaired hospice patients?
- PAINAD scale (Correct answer)
- Wong-Baker FACES scale
- Visual Analog Scale
- McGill Pain Questionnaire
Correct answer: PAINAD scale
The Pain Assessment in Advanced Dementia (PAINAD) scale uses behavioral indicators such as breathing patterns, vocalizations, and body language to assess pain in nonverbal patients.
Question 3: A patient enrolled in hospice care wishes to pursue curative chemotherapy for a newly diagnosed secondary cancer. What is the nurse's most appropriate response?
- Explain that the patient may revoke hospice to pursue curative treatment and can re-enroll later (Correct answer)
- Inform the patient that all curative treatments are permanently forfeited upon hospice enrollment
- Administer the chemotherapy under the hospice benefit as palliative care
- Discharge the patient from hospice without further discussion
Correct answer: Explain that the patient may revoke hospice to pursue curative treatment and can re-enroll later
Patients have the right to revoke the hospice benefit at any time to pursue curative treatment and may re-elect hospice care later if eligible.
Question 4: Which electrolyte imbalance is most commonly associated with end-stage malignancy and can cause confusion, constipation, and cardiac arrhythmias in hospice patients?
- Hypercalcemia (Correct answer)
- Hyponatremia
- Hyperkalemia
- Hypophosphatemia
Correct answer: Hypercalcemia
Hypercalcemia is the most common metabolic emergency in advanced cancer, frequently causing altered mental status, constipation, and cardiac conduction abnormalities.
Question 5: 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)
- Administer intravenous fluids to thin secretions
- Increase the oxygen flow rate to 6 liters per minute
- Perform deep tracheal suctioning every 30 minutes
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 6: 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
- Major depressive disorder
- Post-traumatic stress 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.
CHPN FREE Hospice and Palliative Nurse Questions and Answers 2
A hospice patient with end-stage COPD develops increasingly severe dyspnea despite maximum bronchodilator therapy.
Which pharmacologic intervention is most appropriate for refractory dyspnea?