CHPN General Knowledge 3 — Questions and Answers
Question 1: A hospice patient with renal failure is prescribed morphine. The nurse is most concerned about accumulation of which metabolite?
- Morphine-3-glucuronide (M3G)
- Morphine-6-glucuronide (M6G) (Correct answer)
- Hydromorphone
- Normorphine
Correct answer: Morphine-6-glucuronide (M6G)
Morphine-6-glucuronide (M6G) is an active analgesic metabolite that accumulates in renal failure and can cause prolonged sedation and respiratory depression.
Question 2: Which of the following is the most appropriate initial pharmacological treatment for opioid-induced constipation in a hospice patient?
- Docusate sodium alone
- Bulk-forming laxative such as psyllium
- Stimulant laxative such as senna with or without a stool softener (Correct answer)
- Lactulose as a first-line agent
Correct answer: Stimulant laxative such as senna with or without a stool softener
A stimulant laxative (e.g., senna) combined with a stool softener is the first-line treatment for opioid-induced constipation; docusate alone is insufficient.
Question 3: A family member asks the hospice nurse why their dying loved one is no longer eating. The best response is:
- We should insert a feeding tube to maintain nutrition.
- Decreased appetite and food intake are a natural part of the dying process and do not cause suffering. (Correct answer)
- We will start IV fluids to ensure they stay hydrated.
- Loss of appetite indicates uncontrolled pain that needs treatment.
Correct answer: Decreased appetite and food intake are a natural part of the dying process and do not cause suffering.
Anorexia and decreased oral intake are expected and natural aspects of the dying process; explaining this helps families understand that withholding artificial nutrition is appropriate.
Question 4: Which level of hospice care is designed for short-term pain or symptom management that cannot be managed in the home setting?
- Routine home care
- Continuous home care
- General inpatient care (Correct answer)
- Respite care
Correct answer: General inpatient care
General inpatient care is a Medicare hospice benefit level for acute symptom management requiring skilled nursing or medical intervention that cannot be provided at home.
Question 5: When using an equianalgesic conversion chart to switch a patient from oral oxycodone to IV morphine, the nurse knows that:
- Oral oxycodone 30 mg equals IV morphine 30 mg
- Equianalgesic doses are exact and require no dose adjustment
- A dose reduction of 25–50% is typically applied when converting to account for incomplete cross-tolerance (Correct answer)
- The conversion ratio is fixed regardless of patient age or renal function
Correct answer: A dose reduction of 25–50% is typically applied when converting to account for incomplete cross-tolerance
When rotating opioids, a 25–50% dose reduction is applied to account for incomplete cross-tolerance and individual variation, preventing inadvertent overdose.
Question 6: A hospice patient who is Jewish requests that no procedures be performed after sunset on Friday. The nurse should:
- Document the request and notify the physician to override it if medically necessary
- Respect the request as a cultural and religious practice and document it in the care plan (Correct answer)
- Educate the patient that comfort care always takes priority over religious beliefs
- Consult ethics committee immediately
Correct answer: Respect the request as a cultural and religious practice and document it in the care plan
Respecting religious and cultural practices is a fundamental principle of holistic palliative care; the nurse should honor the patient's Shabbat observance and document it in the plan of care.
Question 7: Which of the following is a hallmark sign that distinguishes terminal secretions ('death rattle') from a pulmonary infection requiring treatment?
- High-grade fever above 38.5°C present with the secretions
- Noisy breathing occurs only in the final hours or days of life in a patient who is unresponsive (Correct answer)
- Yellow or green sputum is being produced
- Patient reports chest tightness with the noisy breathing
Correct answer: Noisy breathing occurs only in the final hours or days of life in a patient who is unresponsive
Terminal secretions occur in unresponsive, actively dying patients in the final hours to days of life and are caused by pooled secretions the patient can no longer clear, not infection.
CHPN General Knowledge 3
A hospice patient with renal failure is prescribed morphine.
The nurse is most concerned about accumulation of which metabolite?