CHPN MCQ Practice 4 — Questions and Answers
Question 1: A patient with advanced cancer reports neuropathic pain described as burning and shooting. In addition to opioids, which adjuvant analgesic is MOST appropriate?
- Ibuprofen
- Prednisone
- Gabapentin (Correct answer)
- Ondansetron
Correct answer: Gabapentin
Gabapentin (and pregabalin) are first-line adjuvant analgesics for neuropathic pain, acting on calcium channels to reduce neuronal excitability.
Question 2: Under the Medicare Hospice Benefit, which service is NOT typically covered?
- Nursing visits related to terminal diagnosis
- Chaplaincy services
- Curative chemotherapy for the terminal diagnosis (Correct answer)
- Bereavement support for the family
Correct answer: Curative chemotherapy for the terminal diagnosis
The Medicare Hospice Benefit requires patients to forgo curative treatment for their terminal illness; disease-modifying or curative therapies are not covered under the hospice benefit.
Question 3: A hospice nurse observes a patient with Cheyne-Stokes respirations. This breathing pattern is characterized by:
- Rapid, deep, labored breathing occurring continuously
- Periods of apnea alternating with cycles of increasing and decreasing respiratory depth (Correct answer)
- Slow, shallow, and irregular respirations without any apneic periods
- Gurgling respirations caused by retained secretions
Correct answer: Periods of apnea alternating with cycles of increasing and decreasing respiratory depth
Cheyne-Stokes respiration is a cyclical pattern of waxing and waning tidal volumes with periodic apnea, common in the final hours to days of life.
Question 4: When a patient lacks decision-making capacity and has no advance directive, the legal hierarchy for surrogate decision-making in most US states typically begins with:
- The attending physician
- The legal next of kin (spouse or adult children) (Correct answer)
- The hospice social worker
- A court-appointed guardian
Correct answer: The legal next of kin (spouse or adult children)
In the absence of an advance directive or durable power of attorney for health care, most US states recognize the legal next of kin—spouse, then adult children—as the default surrogate decision-maker.
Question 5: A hospice nurse is preparing a patient for discharge to home. Which teaching is MOST critical for the family managing opioid medications?
- Flush unused opioids down the toilet after the patient's death
- Store opioids in a locked location away from children and visitors (Correct answer)
- Opioids may be shared with other family members if needed
- Opioids should be kept at room temperature on the kitchen counter for easy access
Correct answer: Store opioids in a locked location away from children and visitors
Opioid medications must be stored securely in a locked location to prevent accidental ingestion by children or diversion by visitors.
Question 6: Which of the following is the hallmark distinction between palliative care and hospice care?
- Palliative care requires a terminal prognosis of six months or less
- Palliative care can be provided alongside curative treatment at any disease stage (Correct answer)
- Hospice care may include curative interventions for the terminal diagnosis
- Palliative care is only provided in inpatient settings
Correct answer: Palliative care can be provided alongside curative treatment at any disease stage
Palliative care can be integrated at any stage of serious illness alongside curative treatment, while hospice requires forgoing curative therapy and a terminal prognosis.
Question 7: A patient receiving parenteral nutrition at home enrolls in hospice. The hospice team should:
- Continue parenteral nutrition indefinitely as it is comfort-focused
- Discuss with the patient and family the goals, benefits, and burdens of continued parenteral nutrition (Correct answer)
- Immediately discontinue parenteral nutrition upon enrollment
- Transfer care back to the oncologist to manage nutrition
Correct answer: Discuss with the patient and family the goals, benefits, and burdens of continued parenteral nutrition
The decision to continue or discontinue parenteral nutrition in hospice requires a goals-of-care conversation weighing potential burdens against perceived benefits for that individual patient.
CHPN MCQ Practice 4
A patient with advanced cancer reports neuropathic pain described as burning and shooting.
In addition to opioids, which adjuvant analgesic is MOST appropriate?