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

Question 1: A hospice nurse is caring for a patient with opioid-induced constipation. The patient has been on scheduled morphine for 2 weeks with no bowel movement in 5 days. Which laxative is MOST appropriate?

Osmotic laxative alone (lactulose)
Methylnaltrexone only
Bulk-forming agent (psyllium)
Stimulant laxative (senna) combined with a stool softener (docusate) (Correct answer)

Correct answer: Stimulant laxative (senna) combined with a stool softener (docusate)

A stimulant laxative plus softener is the standard first-line regimen for opioid-induced constipation in palliative care.

Question 2: A nurse caring for a dying patient notes the family is praying continuously and refuses to discuss the patient's decline. The culturally competent response is to:

Respect the family's spiritual coping and gently offer to be present when they are ready to discuss care (Correct answer)
Document that the family is in denial and refer to social work only
Insist on a family meeting to discuss the prognosis immediately
Limit visiting hours to reduce family stress

Correct answer: Respect the family's spiritual coping and gently offer to be present when they are ready to discuss care

Culturally competent care means respecting spiritual practices as coping mechanisms while remaining available for discussion without forcing it.

Question 3: When performing a spiritual assessment using the FICA framework, the 'I' stands for:

Importance and Influence (Correct answer)
Interventions requested
Illness meaning
Identity

Correct answer: Importance and Influence

In the FICA Spiritual Assessment Tool, 'I' represents Importance and Influence—asking how important spirituality is to the patient and how it influences their health decisions.

Question 4: 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
0.5 mg every 4 hours
5 mg every 4 hours (Correct answer)
20 mg every 4 hours

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 5: Which behavior BEST demonstrates a hospice nurse acting as a patient advocate?

Informing the family of the patient's diagnosis without consent
Documenting patient concerns without taking further action
Following physician orders without question
Ensuring the patient's pain is reassessed after an analgesic and reporting inadequate relief to the physician (Correct answer)

Correct answer: Ensuring the patient's pain is reassessed after an analgesic and reporting inadequate relief to the physician

Advocacy includes actively monitoring outcomes and communicating unresolved symptoms to the care team to ensure patient comfort is achieved.

Question 6: 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)
Dexamethasone
Metoclopramide
Haloperidol

Correct answer: Gabapentin

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

Question 7: Which of the following is a crucial component of supporting the patient's care needs when a hospice patient is dealing with growing weakness, exhaustion, and decreasing mobility?

Remaining as mobile as possible
Honoring the wishes of family members
Seeing as many visitors as possible
Prioritizing energy use (Correct answer)

Correct answer: Prioritizing energy use

Supporting the hospice patient who is progressively weaker and more exhausted requires prioritizing energy consumption. Giving the patient the tools to prioritize their physical, emotional, and spiritual needs will enable them to focus their limited resources on the areas that are most important to them.

Question 8: When advocating for a hospice patient's right to refuse treatment, the nurse should FIRST:

Ask the family to persuade the patient to accept treatment
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

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

Withholding treatment to hasten the patient's death when suffering is uncontrollable
Allowing patients to self-administer lethal doses of medication to end suffering
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 10: Which of the following is an absolute contraindication to the use of meperidine (Demerol) for pain management in hospice patients?

Concurrent use of low-dose aspirin
Concurrent use of a proton pump inhibitor
Renal impairment due to accumulation of the toxic metabolite normeperidine (Correct answer)
Patient allergy to codeine

Correct answer: Renal impairment due to accumulation of the toxic metabolite normeperidine

Meperidine is contraindicated in patients with renal impairment because its metabolite normeperidine accumulates and causes CNS toxicity including seizures.

Question 11: Which statement indicates a family member has understood teaching about the active dying phase?

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

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

Respiratory depression
Pruritus
Tolerance
Constipation (Correct answer)

Correct answer: Constipation

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

Question 13: When the nurse visiting a hospice patient at their residence, he states"I can't stand this pain anymore. I should just shoot myself and be done with it."The optimal first reaction is:

I understand why you feel that way. I'll ask the doctor to prescribe an antidepressant for you.
Massage
"Do you have a plan to hurt yourself?" (Correct answer)
"I'm sure you don't really mean that."

Correct answer: "Do you have a plan to hurt yourself?"

When a patient expresses suicidal ideation, the nurse's immediate and most critical first response is to assess the level of risk. Directly asking 'Do you have a plan to hurt yourself?' is a crucial step in determining the seriousness of the threat and allows the nurse to intervene appropriately and ensure the patient's safety. This direct question is a professional assessment tool, not a judgment.

Question 14: When transitioning a patient from IV morphine to oral morphine, what is the correct conversion ratio (IV to oral)?

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

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 15: The interdisciplinary team in hospice MUST include which core members per Medicare Conditions of Participation?

Physician, registered nurse, social worker, and pastoral or counseling services (Correct answer)
Attending physician and RN only
Nurse practitioner, social worker, chaplain, and dietitian
Physician, RN, pharmacist, and physical therapist

Correct answer: Physician, registered nurse, social worker, and pastoral or counseling services

Medicare requires the hospice IDT to include a physician, RN, social worker, and pastoral/counseling services at minimum.

Question 16: A patient with end-stage liver disease develops ascites causing significant abdominal distension and dyspnea. What non-pharmacological intervention may provide the most relief?

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

Correct answer: Therapeutic paracentesis

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

Question 17: 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?

An exact timeline of when each specific symptom will appear.
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.

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

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

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

Hydromorphone
Morphine
Codeine
Fentanyl (Correct answer)

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

Actively avoiding discussion of the deceased to facilitate moving forward
Strong social support and a sense of having provided good care during the illness (Correct answer)
Rapid return to all normal activities within two to three weeks of the death
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 21: A hospice nurse is caring for a patient with fungating wound odor causing significant distress. Which intervention MOST effectively addresses malodor?

Irrigate with hydrogen peroxide three times daily
Cover the wound with activated charcoal dressings only
Increase dressing frequency to every 2 hours
Apply topical metronidazole gel to the wound (Correct answer)

Correct answer: Apply topical metronidazole gel to the wound

Topical metronidazole targets the anaerobic bacteria responsible for malodor in fungating wounds and is well-supported by evidence.

Question 22: Which psychosocial intervention is most aligned with the hospice philosophy of care for a patient experiencing existential distress near end of life?

Dignity therapy (Correct answer)
Applied behavior analysis
Systematic desensitization
Cognitive behavioral therapy for insomnia

Correct answer: Dignity therapy

Dignity therapy is specifically designed for patients near end of life, focusing on legacy creation, meaning-making, and preserving a sense of purpose and worth.

Question 23: Which anticholinergic medication is commonly used to reduce excessive respiratory secretions ('death rattle') near end of life?

Metoclopramide
Glycopyrrolate (Correct answer)
Lorazepam
Haloperidol

Correct answer: Glycopyrrolate

Glycopyrrolate is an anticholinergic that reduces secretion production without crossing the blood-brain barrier, minimizing CNS side effects.

Question 24: 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
Psychological pain
Drug diversion
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 25: Mottling of the skin (livedo reticularis) in a dying patient indicates:

Allergic drug reaction to opioids
Peripheral circulatory failure as death approaches (Correct answer)
Septicemia requiring immediate antibiotic therapy
Deep vein thrombosis

Correct answer: Peripheral circulatory failure as death approaches

Mottling reflects poor peripheral perfusion and pooling of blood in superficial vessels, a common sign of imminent death.

Question 26: The phrase 'total pain,' coined by Dame Cicely Saunders, refers to:

Pain requiring continuous IV infusion
The physical, psychological, social, and spiritual dimensions of suffering (Correct answer)
Pain rated 10/10 on a numeric scale
Refractory pain unresponsive to opioids

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

Saunders' concept of total pain recognizes that suffering encompasses physical, emotional, social, and spiritual components.

Question 27: A palliative patient's family demands that 'everything be done' but the patient previously completed an advance directive requesting comfort-focused care. The nurse's PRIORITY action is:

Request a psychiatric consult for the patient
Wait for a hospital ethics committee before making any decision
Follow the family's wishes because they know the patient best
Honor the patient's advance directive as it reflects the patient's autonomous wishes when competent (Correct answer)

Correct answer: Honor the patient's advance directive as it reflects the patient's autonomous wishes when competent

A valid advance directive reflects the patient's wishes made while competent and takes precedence over family demands when the patient lacks decision-making capacity.

Question 28: What is 'complicated grief,' also referred to as prolonged grief disorder?

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

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

Physical, psychological, social, and spiritual suffering (Correct answer)
Only physical and emotional pain
Pain rated above 7 on a numeric scale
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 30: A patient with COPD on hospice develops severe breathlessness. After non-pharmacological measures fail, the most evidence-based pharmacological treatment for dyspnea is:

Nebulized furosemide
High-flow oxygen for all dyspneic patients
Benzodiazepines as first-line agents
Low-dose oral or parenteral opioids (Correct answer)

Correct answer: Low-dose oral or parenteral opioids

Low-dose opioids are the most evidence-based pharmacological treatment for dyspnea at end of life, reducing the sensation of breathlessness effectively.

Question 31: A patient with advanced cancer tells the hospice nurse, 'I don't want to talk about dying — I just want you to fix me.' Which communication approach is most appropriate?

Remind the patient firmly that curative treatment is no longer a realistic option
Contact the physician to evaluate whether resuming disease-directed therapy is possible
Document the patient's statement and avoid revisiting the topic in future visits
Explore what 'getting better' means to the patient and what they are most hoping for (Correct answer)

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

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

Question 32: Which medication is most appropriate for managing terminal secretions (death rattle) in a hospice patient?

Methotrexate
Metformin
Glycopyrrolate (Correct answer)
Lisinopril

Correct answer: Glycopyrrolate

Glycopyrrolate is an anticholinergic medication commonly used to reduce terminal secretions by decreasing saliva and mucus production.

Question 33: When advocating for a hospice patient whose family insists on aggressive interventions inconsistent with the patient's advance directive, the nurse should FIRST:

Review the advance directive with the family and clarify the patient's documented wishes (Correct answer)
Administer the aggressive interventions as the family requests
Contact the ethics committee immediately
Discharge the patient from hospice services

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

The nurse's first step should be to review the advance directive with the family, ensuring they understand the patient's previously expressed wishes.

Question 34: When a patient from a culture that does not discuss death openly is admitted to hospice, the nurse should:

Insist on full disclosure of the terminal prognosis to the patient
Limit all end-of-life discussions to family members only
Assess the patient's and family's cultural beliefs and preferences regarding disclosure (Correct answer)
Document refusal of information and proceed with standard hospice education

Correct answer: Assess the patient's and family's cultural beliefs and preferences regarding disclosure

Cultural competence requires assessing individual preferences around disclosure rather than applying a one-size-fits-all approach.

Question 35: 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?

Yes, opioids always hasten death in high doses
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
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 36: Which of the following is a recognized risk factor for developing complicated grief?

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

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

Visual Analog Scale (VAS)
Numeric Rating Scale (NRS)
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
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 38: A patient on long-term opioid therapy develops myoclonus (muscle jerking). Which action is MOST appropriate?

Increase the opioid dose to improve pain control
Immediately discontinue all opioids
Consider opioid rotation and ensure adequate hydration (Correct answer)
Administer naloxone to reverse the opioid effect

Correct answer: Consider opioid rotation and ensure adequate hydration

Opioid-induced myoclonus, often caused by metabolite accumulation, is managed by rotating to a different opioid and ensuring adequate hydration to clear metabolites.

Question 39: A hospice nurse is developing an interdisciplinary care plan for a patient who expresses fear about dying alone. Which team member should be consulted first to address this concern?

The hospice social worker (Correct answer)
The hospice pharmacist
The hospice dietitian
The hospice medical director

Correct answer: The hospice social worker

The hospice social worker is trained to address psychosocial and emotional concerns including fear of dying, and can coordinate volunteer companionship and counseling resources.

Question 40: Which of the following best describes the mechanism by which a bedside fan helps relieve dyspnea in palliative care patients?

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

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 41: Which of the following is the MOST critical initial step in the advance care planning process for a new hospice patient who is capable of making decisions?

Completing a Do Not Resuscitate (DNR) order immediately.
Engaging the patient in a conversation about their values, goals, and preferences for care. (Correct answer)
Identifying a healthcare proxy or surrogate decision-maker.
Having the patient sign a living will and durable power of attorney for health care.

Correct answer: Engaging the patient in a conversation about their values, goals, and preferences for care.

The most critical initial step in advance care planning is to have a meaningful conversation with the patient to understand their values, goals, and wishes for future medical care. This conversation provides the foundation for all subsequent documentation, such as living wills or the appointment of a healthcare proxy. Rushing to complete forms without this understanding can lead to care that does not align with the patient's true preferences.

Question 42: A nurse is teaching a family caregiver about repositioning a bedbound patient. Which statement by the caregiver indicates a need for further teaching?

'I will reposition them every two hours.'
'I only need to reposition when they complain of pain.' (Correct answer)
'I should inspect the skin each time I turn them.'
'I can use pillows to support their position.'

Correct answer: 'I only need to reposition when they complain of pain.'

Repositioning should occur on a scheduled basis (every 2 hours) regardless of complaints, as patients with altered sensation may not report discomfort.

Question 43: A family member asks why their dying loved one is receiving less food and water. The nurse's best response is:

We can start a feeding tube if you prefer
Reduced intake means death will occur within 24 hours
We will start IV fluids to keep them comfortable
The body naturally reduces its need for nutrition and hydration at end of life (Correct answer)

Correct answer: The body naturally reduces its need for nutrition and hydration at end of life

As death approaches, the body's metabolic needs diminish and reduced oral intake is a natural part of the dying process, not a cause of suffering.

Question 44: Which change in a hospice patient's urinary output is MOST consistent with the active dying process?

Polyuria with dilute urine and no color change
Increased urine output with clear, yellow urine
Urinary incontinence with normal volume output
Oliguria with dark, concentrated urine or anuria (Correct answer)

Correct answer: Oliguria with dark, concentrated urine or anuria

As renal perfusion decreases during active dying, urine output drops to oliguria or anuria and urine becomes dark and concentrated.

Question 45: What is the nurse's priority role when a hospice patient's family expresses guilt about choosing comfort care over aggressive treatment?

Refer them immediately to a psychiatrist
Avoid discussing the topic to prevent further distress
Suggest they reconsider curative treatment options
Provide emotional support and normalize their feelings while reinforcing the patient's wishes (Correct answer)

Correct answer: Provide emotional support and normalize their feelings while reinforcing the patient's wishes

The hospice nurse should validate the family's emotions, normalize guilt as a common response, and gently reinforce that the care plan honors the patient's expressed wishes.

Question 46: Which of the following best describes the concept of cultural humility in hospice nursing practice?

Memorizing the customs of each patient's culture
Treating all patients identically regardless of background
Asking patients to adapt to the healthcare system's norms
Maintaining an ongoing process of self-reflection and openness to patients' cultural perspectives (Correct answer)

Correct answer: Maintaining an ongoing process of self-reflection and openness to patients' cultural perspectives

Cultural humility emphasizes lifelong learning, self-reflection, and power-sharing rather than achieving a fixed level of cultural knowledge.

Question 47: 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
13 months (Correct answer)
24 months
30 days

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 48: A patient with end-stage COPD reports air hunger rated 8/10. Their respiratory rate is 28 and O2 sat is 78%. The MOST appropriate intervention is:

Reposition and reassess in 30 minutes
Administer a low-dose opioid as ordered for dyspnea (Correct answer)
Transfer to the emergency department
Increase oxygen to 6 L/min via nasal cannula

Correct answer: Administer a low-dose opioid as ordered for dyspnea

Low-dose opioids are the most effective pharmacologic treatment for refractory dyspnea in end-stage disease and are a hospice standard.

Question 49: Which assessment tool is most appropriate for evaluating delirium in a hospice patient?

Confusion Assessment Method (CAM) (Correct answer)
Braden Scale
Palliative Performance Scale
Edmonton Symptom Assessment System

Correct answer: Confusion Assessment Method (CAM)

The Confusion Assessment Method (CAM) is the validated gold-standard screening tool specifically designed to identify delirium.

Question 50: In hospice care, what is the primary purpose of the interdisciplinary group (IDG) meeting?

To review and update each patient's plan of care collaboratively (Correct answer)
To assign nursing tasks for the upcoming week
To coordinate billing and insurance documentation
To evaluate staff performance and productivity metrics

Correct answer: To review and update each patient's plan of care collaboratively

The IDG meeting is required to review, revise, and document updates to each patient's individualized plan of care with input from all disciplines involved.

Question 51: 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
Discontinue all contact since the patient has died and the hospice episode is closed
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)

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 52: When will her recently deceased grandmother return, wonders a 4-year-old child. Her mother clarifies as follows: She is unable to return. The young person nods, but subsequently poses the same query. As an illustration, consider this as:

Congruence with developmental level (Correct answer)
Denial regarding the permanence of the death
A sign of advanced developmental level
Regression to earlier stage of development

Correct answer: Congruence with developmental level

A 4-year-old child's understanding of death is typically concrete and often lacks the concept of permanence. They may view death as temporary or reversible, or believe the deceased can still return. Repeatedly asking if a deceased person will return, even after being told no, is a normal cognitive and emotional response for this developmental stage.

Question 53: 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?

Reduce agitation and perceptual disturbances to improve patient comfort (Correct answer)
Prevent aspiration by reducing secretion production
Replace opioid analgesia during the final hours
Induce unconsciousness to reduce the family's distress

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 54: Which statement BEST describes the goal of palliative sedation in refractory symptom management?

To maintain full alertness while controlling pain
To eliminate all opioid use and replace with sedatives
To reduce consciousness to the level needed to relieve intractable suffering (Correct answer)
To hasten death and relieve suffering simultaneously

Correct answer: To reduce consciousness to the level needed to relieve intractable suffering

Palliative sedation is titrated to the minimum level of sedation necessary to achieve patient comfort, not to cause death.

Question 55: A hospice patient receiving oral morphine 15 mg every 4 hours is being converted to an equianalgesic IV dose. What is the correct IV morphine equivalent?

15 mg IV
10 mg IV
7.5 mg IV
5 mg IV (Correct answer)

Correct answer: 5 mg IV

The oral-to-IV morphine conversion ratio is 3:1, so 15 mg oral morphine equals 5 mg IV morphine.

Question 56: Which theorist developed the concept of 'tasks of mourning' as an active alternative to passive stage-based grief models?

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

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 57: 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?

Increased urine output and restlessness
Bradypnea with regular rhythm and strong pulse
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 58: Which ethical principle is MOST directly supported when a hospice team honors a patient's advance directive refusing cardiopulmonary resuscitation?

Justice
Beneficence
Autonomy (Correct answer)
Non-maleficence

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

30 mg oxycodone/day
40 mg oxycodone/day (Correct answer)
60 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 60: A CHPN notes that a patient on 60 mg oral morphine every 4 hours is requesting breakthrough doses every 2 hours. What is the MOST appropriate next step?

Switch the patient to a non-opioid analgesic
Administer the breakthrough dose on request without changing the scheduled dose
Notify the physician to reassess and consider increasing the scheduled opioid dose (Correct answer)
Withhold the breakthrough dose because the patient is requesting too frequently

Correct answer: Notify the physician to reassess and consider increasing the scheduled opioid dose

Frequent breakthrough dose use (more than 3 times in 24 hours) indicates inadequate baseline analgesia and the scheduled dose should be titrated up.

Question 61: When educating a family about oral care for a non-responsive dying patient, the nurse should instruct them to:

Apply petroleum jelly to the lips and skip oral care
Avoid any oral care to prevent disturbing the patient
Use moistened swabs to keep lips and mouth moist and avoid aspiration risk (Correct answer)
Use a standard toothbrush with toothpaste twice daily

Correct answer: Use moistened swabs to keep lips and mouth moist and avoid aspiration risk

Moistened swabs keep mucosal membranes comfortable and reduce the aspiration risk associated with using a toothbrush or large amounts of liquid in a non-responsive patient.

Question 62: What characterizes 'disenfranchised grief,' a concept developed by Kenneth Doka?

Grief limited to immediate family members and not extended to friends or coworkers
Grief that is excessively prolonged beyond socially accepted timeframes
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 63: 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)
Rando and Stroebe
Worden and Parkes
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 64: Which of the following is NOT considered a normal grief reaction?

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

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 65: A hospice nurse notes a patient has Cheyne-Stokes respirations. This finding most likely indicates:

Approaching death, typically within hours to days (Correct answer)
Uncontrolled pain causing respiratory distress
Need for supplemental oxygen titration
Acute pulmonary edema requiring immediate intervention

Correct answer: Approaching death, typically within hours to days

Cheyne-Stokes respirations — cycles of apnea and hyperpnea — are a common sign of imminent death, typically occurring hours to days before death.

Question 66: 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.
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.
Side with the discipline that has the longest-standing relationship with the patient.

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 67: 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?

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

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 68: 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?

Replace the patch immediately and apply a new one
Assess for fever, as hyperthermia increases fentanyl absorption and may cause toxicity
Administer an oral immediate-release opioid for breakthrough pain (Correct answer)
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 69: Which educational topic is MOST important for a family caring for a hospice patient at home regarding medication safety?

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

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 70: 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
Reduce the dose and extend the dosing interval (Correct answer)
Use standard doses with no adjustment needed

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

Arrange for a qualified professional interpreter and provide materials in the family's language (Correct answer)
Speak slowly and use gestures to communicate
Use the patient's bilingual teenage grandchild to interpret
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 72: Which of these services is not included in the Medicare Benefit for Hospice?

Light housekeeping
Medication management
Personal care
Pet therapy (Correct answer)

Correct answer: Pet therapy

The Medicare Hospice Benefit covers a comprehensive range of services, including personal care, light housekeeping (as it relates to patient care), medication management, nursing care, and social work. While pet therapy can be beneficial for emotional support, it is generally considered an ancillary or complementary service and is not explicitly covered as a core service under the standard Medicare Hospice Benefit.

Question 73: A hospice patient with advanced heart failure develops Cheyne-Stokes respirations. What is the most appropriate nursing intervention?

Administer supplemental oxygen at high flow
Suction the airway every 15 minutes
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

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 74: Which action best demonstrates the hospice nurse's role in supporting staff wellness and preventing burnout?

Limiting staff exposure to terminal patients
Assigning additional responsibilities to keep staff engaged
Facilitating regular debriefing sessions after difficult patient deaths (Correct answer)
Discouraging staff from discussing difficult cases

Correct answer: Facilitating regular debriefing sessions after difficult patient deaths

Structured debriefing after losses provides psychological support and is a recognized strategy for reducing compassion fatigue.

Question 75: 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 76: A hospice nurse is educating the interdisciplinary team about anticipatory grief. Which description is MOST accurate?

It is a pathological response that always requires psychiatric intervention
It is the grief experienced before an expected death, allowing emotional preparation for the loss (Correct answer)
Anticipatory grief only occurs in patients and does not affect family members
Anticipatory grief eliminates the need for bereavement support after the patient dies

Correct answer: It is the grief experienced before an expected death, allowing emotional preparation for the loss

Anticipatory grief is the normal process of mourning that begins before the actual death, experienced by both patients and families as they prepare for the impending loss.

Question 77: Which of the following best describes the concept of 'double effect' as it applies to palliative care?

The dual role of the nurse as both caregiver and patient advocate
An action intended to provide comfort may unintentionally hasten death, which is ethically permissible (Correct answer)
Giving two doses of morphine to ensure adequate pain relief
Using two different opioid medications simultaneously for better pain control

Correct answer: An action intended to provide comfort may unintentionally hasten death, which is ethically permissible

The doctrine of double effect holds that an action with a good intended effect (comfort) is ethically permissible even if it has a foreseeable but unintended harmful side effect (possible hastening of death).

Question 78: What is 'resilience' in the context of bereavement research and clinical practice?

The complete absence of grief symptoms following a significant loss
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)
Suppressing grief emotions in order to remain productive and functional at work

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

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

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 80: Which route of opioid administration is most appropriate for a hospice patient in the active dying phase who can no longer swallow oral medications?

Rectal suppositories as the only option
Oral tablets crushed in water
Intramuscular injection
Sublingual or buccal (Correct answer)

Correct answer: Sublingual or buccal

Sublingual or buccal administration allows mucosal absorption without swallowing and is preferred for comfort in actively dying patients.

Question 81: A family member insists that the patient be given IV fluids because 'they are starving.' The hospice nurse's MOST therapeutic response is:

Explain that dehydration in dying patients often reduces secretions and edema, and the patient may not experience thirst or hunger (Correct answer)
Tell the family that feeding is prohibited under hospice philosophy
Document the family's refusal to accept hospice philosophy and notify the team
Initiate IV fluids immediately to address the family's concerns

Correct answer: Explain that dehydration in dying patients often reduces secretions and edema, and the patient may not experience thirst or hunger

Educating the family that natural dehydration near end of life is typically not distressing and may reduce discomfort addresses their concern therapeutically.

Question 82: A hospice nurse is planning care for a patient with a PPS (Palliative Performance Scale) score of 30%. Which finding is most consistent with this score?

The patient is ambulatory with occasional assistance needed
The patient is mainly bedbound with extensive assistance required for self-care (Correct answer)
The patient is able to do significant work activity with some disease evidence
The patient requires total care and is completely bedbound with no oral intake

Correct answer: The patient is mainly bedbound with extensive assistance required for self-care

A PPS score of 30% indicates a patient who is mainly bedbound, unable to do any activity, requiring extensive assistance, and having reduced oral intake.

Question 83: A hospice nurse is assessing a nonverbal patient for pain. Which tool is MOST appropriate?

Visual Analog Scale (VAS)
McGill Pain Questionnaire
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Numeric Rating Scale (NRS 0-10)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

PAINAD evaluates breathing, vocalization, facial expression, body language, and consolability in patients who cannot self-report pain.

Question 84: A hospice nurse documents a patient's prognosis using the Palliative Prognostic Score (PaP). Which variable is included in PaP calculation?

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

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 85: A patient receiving hospice care with a lengthy history of complications from hypothyroidism are actively killing people of heart illness. The individual is unable to consume pills orally. The nurse must to:

Administer the levothyroxine topically
Obtain liquid levothyroxine
Hold the levothyroxine (Correct answer)
Maintain open intravenous (IV) access

Correct answer: Hold the levothyroxine

The best course of action, considering the patient's fatal condition and incapacity to swallow pills, would be to: Hold the levo<br><br>thyroxine Sustaining the patient on medication that they are unable to take could not be very beneficial and might even put them through needless suffering. Prioritizing comfort measures and providing supportive care that is suited to the patient's end-of-life needs is crucial for the nurse.

Question 86: How frequently must a registered nurse visit the patient's home to supervise a hospice assistant in accordance with Medicare guidelines?

Once every 14 days (Correct answer)
Once every 7 days
Once every 30 days
Once every benefit period

Correct answer: Once every 14 days

A registered nurse must visit the patient's home at least once every 14 days to oversee the hospice aide's care, as required by the Medicare Conditions of Participation for Hospices. If no area of concern has been identified, the hospice aide does not need to be present during the visit.

Question 87: Which of the following best describes anticipatory grief?

Grief that is delayed until after the patient's death
Grief experienced before the anticipated loss of a loved one (Correct answer)
Grief lasting more than 12 months post-death
Grief complicated by a history of trauma

Correct answer: Grief experienced before the anticipated loss of a loved one

Anticipatory grief begins before the death as family members mourn losses already occurring (function, role, future) and prepare emotionally.

Question 88: Which of the following non-pharmacological interventions is a manipulative and body-based practice that a CHPN can employ to manage a patient's pain and provide comfort?

Aromatherapy
Guided imagery
Music therapy
Gentle massage (Correct answer)

Correct answer: Gentle massage

Gentle massage is a manipulative, body-based therapy that can help ease muscle tension, improve circulation, and promote relaxation, thereby reducing pain perception. While guided imagery, music therapy, and aromatherapy are valuable non-pharmacological interventions, they are classified differently (e.g., mind-body or sensory therapies) and do not primarily involve physical manipulation of the body's tissues.

Question 89: Which description best defines 'total pain' as conceptualized in palliative care?

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

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 90: 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)
Using multiple opioids simultaneously
Reducing the opioid dose by rotating to non-opioid drugs
Alternating opioids daily to prevent tolerance

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 91: When performing a comprehensive pain assessment on a hospice patient who is non-verbal and cognitively impaired, which tool is most appropriate?

McGill Pain Questionnaire
Visual Analog Scale (VAS)
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Numeric Rating Scale (NRS 0–10)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale was specifically developed and validated for assessing pain in patients with advanced dementia or those who cannot self-report. It evaluates observable behaviors such as breathing, vocalization, facial expression, body language, and consolability. Self-report tools like the NRS or VAS require the patient to communicate their experience, making them unsuitable for this population.

Question 92: A bereaved family member reports feeling angry at the deceased for 'leaving them.' What is the most appropriate nursing response?

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

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 93: A family member insists the hospice nurse 'do something' when the patient stops eating near death. The BEST response is:

Explain that decreased intake is a normal part of the dying process (Correct answer)
Start a nasogastric tube to ensure nutrition
Consult nutrition services for parenteral support
Encourage forcing fluids to prevent dehydration

Correct answer: Explain that decreased intake is a normal part of the dying process

Educating families that anorexia near death is physiologic and normal reduces distress and prevents harmful interventions.

Question 94: 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)
Neuropathic burning pain
Colic-type visceral pain
Phantom limb 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 95: Which community resource should a hospice nurse PRIMARILY refer an overwhelmed family caregiver to for temporary relief?

Long-term care facility admission
Inpatient psychiatric unit
Emergency department
Respite care services (Correct answer)

Correct answer: Respite care services

Respite care provides temporary relief for family caregivers and is a covered benefit under the Medicare Hospice Benefit.

Question 96: What is the primary purpose of bereavement follow-up after a patient's death in hospice care?

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

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 97: When performing a bereavement follow-up call to a widow six weeks after her husband's death, the nurse notes she is sleeping only 2 hours per night and has stopped eating. This MOST likely indicates:

Medication side effects from current prescriptions
Complicated grief or major depression requiring further assessment (Correct answer)
Spiritual distress requiring immediate chaplain referral
Normal grief that requires no intervention

Correct answer: Complicated grief or major depression requiring further assessment

Severe insomnia and inability to eat at six weeks post-loss are warning signs of complicated grief or major depressive disorder requiring clinical assessment.

Question 98: 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
Physostigmine; monitor for seizures
Flumazenil; monitor for sedation
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 99: What is the primary goal of the hospice interdisciplinary team (IDT) meeting?

Assign nursing tasks to each team member
Determine billing codes for the visit period
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 100: Which validated tool is most commonly used to assess delirium in hospice and palliative care patients?

Confusion Assessment Method (CAM) (Correct answer)
Mini-Mental State Examination (MMSE)
Brief Psychiatric Rating Scale (BPRS)
Montreal Cognitive Assessment (MoCA)

Correct answer: Confusion Assessment Method (CAM)

The Confusion Assessment Method (CAM) is the most widely validated and used tool for diagnosing delirium in clinical and palliative care settings.

Question 101: What is 'anticipatory grief'?

Grief observed in young children who cannot fully understand the concept of death
Grief characterized by delayed emotional responses occurring months after death
Grief experienced in advance of an expected loss, often during a terminal illness (Correct answer)
Grief experienced intensely after an unexpected traumatic death

Correct answer: Grief experienced in advance of an expected loss, often during a terminal illness

Anticipatory grief occurs before the actual death as patients and families begin mourning losses of function, roles, and future plans while the patient is still living with a terminal illness.

Question 102: Which non-pharmacological intervention has the strongest evidence for reducing pain perception in hospice patients?

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

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

Early grief follows one predictable track while later grief transitions to a different track
Grief proceeds on two separate tracks for spousal bereavement versus parental bereavement
The first track addresses emotional grief while the second track addresses physical health impacts
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 104: 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?

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

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 105: A hospice nurse is asked to precept a new graduate nurse. Which teaching approach best aligns with adult learning principles?

Using case-based, problem-centered scenarios relevant to actual patient care (Correct answer)
Providing detailed lectures covering all policies at once
Assigning self-study modules without clinical discussion
Requiring memorization of drug dosing tables first

Correct answer: Using case-based, problem-centered scenarios relevant to actual patient care

Adult learners are problem-centered and motivated by real-world relevance; case-based scenarios are the most effective teaching method.

Question 106: Under the Medicare Hospice Benefit, which level of care is provided in a hospice facility or hospital for short-term pain and symptom management?

Respite care
General inpatient care (GIP) (Correct answer)
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 107: When calculating an appropriate breakthrough opioid dose, what percentage of the total daily opioid dose should typically be used?

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

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 108: Which approach best supports health literacy when educating a patient with low literacy about medication schedules?

Use the teach-back method with simple language and visual aids (Correct answer)
Provide detailed written instructions with medical terminology
Give a pamphlet and ask if they have questions
Explain the regimen once verbally and document education provided

Correct answer: Use the teach-back method with simple language and visual aids

The teach-back method combined with plain language and visuals is the gold standard for confirming understanding in patients with low health literacy.

Question 109: When discussing advance directives with a patient, the hospice nurse's PRIMARY role is to:

Defer all advance care planning to the attending physician
Complete the POLST form on behalf of the patient
Ensure the patient understands their options and documents their wishes (Correct answer)
Advise the patient to choose DNR status

Correct answer: Ensure the patient understands their options and documents their wishes

The nurse's primary role is patient education and facilitating autonomous decision-making, not directing the patient toward any particular choice.

Question 110: Kübler-Ross's five stages of grief include all of the following EXCEPT:

Acceptance
Denial
Anger
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 111: Which statement best describes the difference between 'grief' and 'bereavement'?

Bereavement occurs before death during caregiving; grief only begins after the patient has died
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
Grief is always pathological in nature; bereavement describes the normal adjustment process

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 112: A hospice nurse overhears a colleague making a derogatory remark about a dying patient's lifestyle. The nurse should first:

Immediately report the colleague to the state board
Inform the patient of what was said
Address the colleague directly and remind them of professional conduct expectations (Correct answer)
Document the incident in the patient's chart

Correct answer: Address the colleague directly and remind them of professional conduct expectations

Direct peer feedback is the first step in addressing unprofessional conduct before escalating to formal reporting.

Question 113: A hospice patient develops myoclonus and increased sedation after a recent opioid dose increase. What is the most likely cause?

Opioid addiction
Drug-seeking behavior
Uncontrolled anxiety
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 114: According to CMS Conditions of Participation, Medicare-certified hospice programs must provide bereavement services for at least how long following a patient's death?

24 months
13 months (Correct answer)
6 months
3 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 115: In palliative care, the term 'total pain' (as coined by Dame Cicely Saunders) encompasses which dimensions?

Physical and psychological dimensions only
Physical, financial, and social dimensions
Physical, psychological, social, and spiritual dimensions (Correct answer)
Psychological and spiritual dimensions only

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

Dame Cicely Saunders, founder of the modern hospice movement, defined 'total pain' as a multidimensional concept encompassing physical, psychological, social, and spiritual suffering. Effective hospice nursing addresses all four dimensions rather than treating pain as purely a physical phenomenon.

Question 116: A palliative nurse notes a patient's pain worsens significantly at night. Which factor should be assessed first?

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

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 117: What best describes the concept of 'double effect' in hospice and palliative nursing?

Using two medications for better symptom control
Providing double the recommended opioid dose
An action intended to relieve suffering may hasten death as a foreseen but unintended consequence (Correct answer)
Administering two doses when the first is ineffective

Correct answer: An action intended to relieve suffering may hasten death as a foreseen but unintended consequence

The doctrine of double effect holds that an action to relieve suffering is ethically permissible even if it may foreseeably hasten death, provided death is not the intended outcome.

Question 118: Pain due to stimulants which does not normally provoke pain is:

Hyperalgesic
Allodyina (Correct answer)
Neuralgia
Paresthesia

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 119: A hospice patient's POLST form indicates 'DNR/DNI.' During a home visit, the patient's family begins CPR. The nurse should:

Leave the home and call the physician
Assist with CPR to support the family
Calmly stop CPR, explain the patient's wishes, and provide comfort-focused care (Correct answer)
Call 911 immediately

Correct answer: Calmly stop CPR, explain the patient's wishes, and provide comfort-focused care

The nurse must uphold the patient's legal POLST directive by stopping CPR, educating the family calmly, and redirecting to comfort care.

Question 120: A hospice nurse is assessing a patient's medication burden. Which term describes the process of reducing or stopping medications that are no longer aligned with comfort-focused goals?

Medication reconciliation
Polypharmacy reduction
Formulary substitution
Deprescribing (Correct answer)

Correct answer: Deprescribing

Deprescribing is the intentional, supervised tapering or stopping of medications that no longer provide benefit or are inconsistent with the patient's comfort-oriented goals of care.

Question 121: During an interdisciplinary team (IDT) meeting, which document MOST directly guides the hospice plan of care revision?

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

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

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)
To exclusively monitor participants for suicidal ideation and refer to crisis services as needed

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 123: The needs of dying patients were disregarded in acute care settings, which gave rise to the modern hospice movement. Unlike acute care, hospice focuses on:

Improvement of abnormal blood work
Comfort of the patient (Correct answer)
Prolonging life
Monitoring the disease process

Correct answer: Comfort of the patient

The modern hospice movement emerged to address the unmet needs of dying patients in acute care, which often prioritized cure over comfort. Unlike acute care, hospice care focuses on providing holistic comfort, managing symptoms, and enhancing the quality of life for patients and their families during the end-of-life journey. The primary goal is patient comfort and dignity.

Question 124: A hospice patient's advance directive states 'no artificial nutrition.' The patient's adult child insists on a feeding tube. The nurse's BEST action is to:

Advocate for the patient's documented wishes and involve the interdisciplinary team (Correct answer)
Ask the physician to order the feeding tube to keep peace
Defer to the family's wishes to avoid conflict
Remove the advance directive from the chart temporarily

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

The nurse's primary advocacy role is to uphold the patient's documented wishes and engage the interdisciplinary team and ethics resources as needed.

Question 125: A nurse documents the patient's appetite using a validated tool. The Simplified Nutritional Appetite Questionnaire (SNAQ) predicts which outcome in palliative patients?

Significant weight loss and nutritional decline (Correct answer)
Likelihood of requiring parenteral nutrition
Dehydration severity
Risk of aspiration pneumonia

Correct answer: Significant weight loss and nutritional decline

SNAQ is validated to predict significant weight loss (≥5% in 6 months) in community-dwelling and palliative patients, guiding nutritional intervention decisions.

Question 126: A hospice patient develops terminal restlessness (terminal agitation). The MOST appropriate pharmacologic intervention is:

High-dose corticosteroids
Haloperidol or midazolam (Correct answer)
Acetaminophen scheduled dosing
Stimulants such as methylphenidate

Correct answer: Haloperidol or midazolam

Haloperidol addresses delirium-related agitation and midazolam provides sedation for refractory terminal restlessness.

Question 127: A family member asks the hospice nurse why artificial nutrition is not being recommended for their loved one who has stopped eating. The BEST educational response is:

The patient must request artificial nutrition themselves before it can be considered
Hospice policy prohibits all forms of artificial nutrition for enrolled patients
As the body naturally shuts down, artificial nutrition can increase discomfort and complications such as aspiration (Correct answer)
Artificial nutrition is too expensive to provide in the home setting

Correct answer: As the body naturally shuts down, artificial nutrition can increase discomfort and complications such as aspiration

During the dying process, the body's decreased ability to process nutrition means artificial feeding can lead to complications like fluid overload, aspiration, and increased discomfort.

Question 128: A patient with advanced renal failure on hospice develops hiccups that have persisted for 3 days. Which medication is MOST commonly used to treat intractable hiccups in palliative care?

Lorazepam
Gabapentin
Metoclopramide
Chlorpromazine or haloperidol (Correct answer)

Correct answer: Chlorpromazine or haloperidol

Chlorpromazine is the only FDA-approved drug for hiccups; haloperidol is commonly used off-label with good evidence in palliative settings.

Question 129: Which medication is most commonly used to manage terminal secretions (death rattle) in a hospice patient?

Metoclopramide
Dexamethasone
Glycopyrrolate (Correct answer)
Furosemide

Correct answer: Glycopyrrolate

Glycopyrrolate is an anticholinergic agent that effectively reduces terminal secretions by decreasing saliva and mucus production.

Question 130: A hospice agency is preparing for a state survey. Which documentation element is most critical for demonstrating compliance with hospice regulations?

Annual employee satisfaction survey results
Staff meeting attendance records
Evidence that the plan of care is reviewed by the IDG at least every 15 days (Correct answer)
Marketing materials distributed to referral sources

Correct answer: Evidence that the plan of care is reviewed by the IDG at least every 15 days

Medicare Conditions of Participation require that the interdisciplinary group review each patient's plan of care at intervals no greater than every 15 days.

Question 131: According to Worden's tasks of mourning, which task involves accepting the reality of the loss?

Task II — Processing the pain of grief
Task I — Accepting the reality of the loss (Correct answer)
Task III — Adjusting to a world without the deceased
Task IV — Finding an enduring connection with 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 132: A hospice nurse is explaining the difference between palliative sedation and euthanasia to a family. Which statement is ACCURATE?

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

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 133: A hospice patient with terminal cancer develops hypercalcemia. Which symptom would the nurse MOST likely assess?

Confusion, polyuria, nausea, and constipation (Correct answer)
Peripheral edema and weight gain
Hyperreflexia and muscle spasms
Hypotension and bradycardia exclusively

Correct answer: Confusion, polyuria, nausea, and constipation

Hypercalcemia of malignancy classically presents with confusion, polyuria, nausea, constipation, and lethargy (bones, moans, groans, psychic overtones).

Question 134: 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
Intramuscular injection
Rectal suppository only
Sublingual or buccal administration (Correct answer)

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 135: Which scale is most appropriate for assessing pain in a non-verbal hospice patient with advanced dementia?

PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
McGill Pain Questionnaire
Visual Analog Scale (VAS)
Numeric Rating Scale (NRS 0–10)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale uses behavioral observations (breathing, vocalization, facial expression, body language, consolability) to estimate pain in non-verbal dementia patients.

Question 136: Which statement about the Palliative Performance Scale (PPS) is CORRECT?

PPS measures cognitive function primarily
A PPS of 10-20% correlates with total dependence and minimal oral intake, suggesting death within days to weeks (Correct answer)
PPS scores below 50% are ineligible for the Medicare Hospice Benefit
A PPS of 100% indicates the patient is actively dying

Correct answer: A PPS of 10-20% correlates with total dependence and minimal oral intake, suggesting death within days to weeks

PPS 10-20% indicates total dependence, mouth care only or no intake, and typically correlates with death within days to weeks.

Question 137: A hospice patient on long-acting morphine reports breakthrough pain occurring 5-6 times per day. What is the most appropriate intervention?

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

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 138: Which ethical principle is MOST directly applied when a hospice nurse honors a patient's refusal of artificial nutrition and hydration?

Justice
Nonmaleficence
Beneficence
Autonomy (Correct answer)

Correct answer: Autonomy

Autonomy is the ethical principle that upholds an individual's right to make informed decisions about their own care, including the right to refuse any treatment. When a nurse respects a patient's refusal of artificial nutrition and hydration, she is enacting that patient's self-determination.

Question 139: 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)
Bisacodyl suppository
Lactulose

Correct answer: Methylnaltrexone (Relistor)

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

Question 140: A patient receiving intrathecal opioid therapy for refractory pain reports sudden severe headache. What serious complication should the nurse suspect first?

Opioid withdrawal
Opioid toxicity
Post-dural puncture headache or catheter migration (Correct answer)
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 141: What does Stroebe and Schut's 'dual process model' of grief describe?

The dual caregiver and mourner roles experienced by family members
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)

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

Diphenhydramine
Ondansetron
Pamidronate
Senna (Correct answer)

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

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

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 144: 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 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)
A 70-year-old with a close-knit religious community whose sibling died peacefully in an inpatient hospice

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 145: 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
Incident pain
Visceral pain (Correct answer)

Correct answer: Visceral pain

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

Question 146: Due to the significant immune system suppression caused by the AIDS virus patients have a higher risk of contracting opportunistic infections due to the most typical of which is:

Tuberculosis
Disseminated CMV (cytomegalovirus)
PCP (pneumocystis carini pneumonia) (Correct answer)
Pseudomonas

Correct answer: PCP (pneumocystis carini pneumonia)

Patients with AIDS experience severe immunosuppression, making them highly susceptible to opportunistic infections. Pneumocystis carinii pneumonia (PCP), now often referred to as Pneumocystis jirovecii pneumonia, was historically and remains one of the most common and life-threatening opportunistic infections in individuals with AIDS, especially before the widespread use of effective antiretroviral therapy.

Question 147: A patient on long-term opioid therapy reports that the same dose no longer provides adequate relief. This phenomenon is best described as:

Pseudoaddiction
Drug addiction
Disease progression only
Opioid tolerance (Correct answer)

Correct answer: Opioid tolerance

Opioid tolerance is the pharmacologic phenomenon in which a given dose produces less effect over time, requiring dose escalation — it is distinct from addiction.

Question 148: What is the primary purpose of palliative sedation in hospice care?

To hasten the dying process when the patient requests it
To eliminate the need for family presence during active dying
To relieve refractory symptoms that have not responded to standard palliative interventions (Correct answer)
To replace opioid therapy in patients with substance use history

Correct answer: To relieve refractory symptoms that have not responded to standard palliative interventions

Palliative sedation is used as a last resort to reduce consciousness and relieve intractable suffering from symptoms that are truly refractory to all other treatments.

Question 149: The most prevalent lung disease at its end stage observed in hospice environments is:

Cystic fibrosis
Chronic obstructive pulmonary disease (COPD)
Tuberculosis
Lung cancer (Correct answer)

Correct answer: Lung cancer

COPD is the most frequent respiratory condition observed in hospice settings, after lung cancer.

Question 150: 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.

Atelectasis
Pneumonia
Cardiac tamponade
Pneumothorax (Correct answer)

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

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
Override the patient's report and treat as 7/10

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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