CHPN MCQ Practice 3 — Questions and Answers
Question 1: A hospice patient with end-stage heart failure develops refractory ascites causing severe discomfort. The most appropriate palliative intervention is:
- Initiate peritoneal dialysis
- Perform therapeutic paracentesis for symptom relief (Correct answer)
- Increase diuretic doses indefinitely
- Recommend surgical shunt placement
Correct answer: Perform therapeutic paracentesis for symptom relief
Therapeutic paracentesis provides rapid relief of discomfort caused by refractory ascites when other measures are insufficient in palliative care.
Question 2: Which medication is MOST appropriate for managing death rattle (terminal secretions) in a dying patient?
- Furosemide IV push
- Glycopyrrolate or hyoscine hydrobromide (Correct answer)
- Nebulized saline treatments
- Aggressive oropharyngeal suctioning
Correct answer: Glycopyrrolate or hyoscine hydrobromide
Anticholinergic agents such as glycopyrrolate or hyoscine (scopolamine) dry secretions and are the pharmacological treatment of choice for terminal respiratory secretions.
Question 3: A palliative care nurse documents a Karnofsky Performance Scale score of 30 for a patient. This score indicates the patient is:
- Able to care for self but unable to do active work
- Severely disabled, hospitalization indicated (Correct answer)
- Normal activity with minor signs of disease
- Dead
Correct answer: Severely disabled, hospitalization indicated
A Karnofsky score of 30 indicates severe disability, unable to care for self, requiring hospitalization or equivalent institutional care.
Question 4: Which of the following is the primary goal when managing pain in a patient who is actively dying and no longer able to swallow?
- Switch to PRN-only dosing to avoid oversedation
- Discontinue opioids to avoid hastening death
- Convert to an equivalent subcutaneous or IV continuous infusion (Correct answer)
- Administer oral medications via nasogastric tube
Correct answer: Convert to an equivalent subcutaneous or IV continuous infusion
When a patient can no longer swallow, maintaining comfort requires converting opioids to an equivalent parenteral or subcutaneous route to ensure continuous pain control.
Question 5: A nurse caring for a patient of a different cultural background notices the family is making all medical decisions without consulting the patient. The nurse should first:
- Report the family for violating the patient's rights
- Explore the patient's own wishes and preferences regarding decision-making roles (Correct answer)
- Insist on speaking with the patient alone
- Document that informed consent was not obtained
Correct answer: Explore the patient's own wishes and preferences regarding decision-making roles
Culturally competent care requires assessing the patient's own preferences about family-centered decision-making before assuming Western autonomy norms apply.
Question 6: Which scale is specifically designed and validated to assess pain in non-communicative patients with dementia?
- Visual Analog Scale (VAS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Brief Pain Inventory (BPI)
- McGill Pain Questionnaire
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
The PAINAD scale assesses pain in non-verbal dementia patients by observing breathing, vocalization, facial expression, body language, and consolability.
Question 7: A patient taking fentanyl patches is switched to oral morphine. The nurse should understand that equianalgesic conversion requires:
- Starting at 50% of the calculated equianalgesic dose to account for incomplete cross-tolerance (Correct answer)
- Giving exactly the same milligram dose in the new opioid
- Doubling the calculated dose to prevent undertreated pain
- No dose adjustment because all opioids are equivalent milligram-for-milligram
Correct answer: Starting at 50% of the calculated equianalgesic dose to account for incomplete cross-tolerance
When rotating opioids, it is standard practice to reduce the calculated equianalgesic dose by 25–50% to account for incomplete cross-tolerance and individual variation.
CHPN MCQ Practice 3
A hospice patient with end-stage heart failure develops refractory ascites causing severe discomfort.
The most appropriate palliative intervention is: