CHPN MCQ Practice 2 — Questions and Answers
Question 1: A hospice nurse notes a patient's urine output has dropped to 200 mL over 24 hours. This finding most likely indicates:
- Urinary tract infection requiring antibiotics
- Active dying process with normal physiological shutdown (Correct answer)
- Dehydration requiring IV fluid replacement
- Renal failure requiring nephrology consult
Correct answer: Active dying process with normal physiological shutdown
Decreased urine output in the final days of life reflects normal physiologic shutdown of the dying process, not a condition requiring aggressive intervention.
Question 2: Which of the following best describes 'total pain' as conceptualized by Dame Cicely Saunders?
- Pain measurable only by numeric rating scales
- Suffering that encompasses physical, emotional, social, and spiritual dimensions (Correct answer)
- Chronic pain requiring opioid rotation
- Neuropathic pain unresponsive to standard analgesics
Correct answer: Suffering that encompasses physical, emotional, social, and spiritual dimensions
Saunders' concept of total pain recognizes that suffering in terminal illness is multidimensional, encompassing physical, psychological, social, and spiritual components.
Question 3: A patient on long-term morphine for cancer pain reports new-onset myoclonus. The most appropriate initial intervention is:
- Add diazepam to suppress myoclonus
- Opioid rotation to hydromorphone (Correct answer)
- Discontinue all opioids immediately
- Increase the morphine dose to cover breakthrough pain
Correct answer: Opioid rotation to hydromorphone
Myoclonus from opioid metabolite accumulation (morphine-6-glucuronide) is best managed by rotating to a different opioid such as hydromorphone, which has fewer neuroexcitatory metabolites.
Question 4: 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
- The body naturally reduces its need for nutrition and hydration at end of life (Correct answer)
- Reduced intake means death will occur within 24 hours
- We will start IV fluids to keep them comfortable
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 5: Which ethical principle is MOST directly applied when a competent patient refuses a blood transfusion based on religious beliefs?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Nonmaleficence
Correct answer: Autonomy
Autonomy grants competent individuals the right to make their own healthcare decisions, including refusal of life-sustaining treatment for religious or personal reasons.
Question 6: 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
- Low-dose oral or parenteral opioids (Correct answer)
- Benzodiazepines as first-line agents
- High-flow oxygen for all dyspneic patients
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 7: The hospice interdisciplinary team meets to update a patient's plan of care. Which team member's role includes addressing the patient's sense of meaning and spiritual distress?
- Social worker
- Home health aide
- Chaplain or spiritual care provider (Correct answer)
- Bereavement coordinator
Correct answer: Chaplain or spiritual care provider
The chaplain or spiritual care provider is the primary team member responsible for assessing and addressing spiritual distress and meaning-making in hospice care.
CHPN MCQ Practice 2
A hospice nurse notes a patient's urine output has dropped to 200 mL over 24 hours.
This finding most likely indicates: