CHPN MCQ Practice 5 — Questions and Answers
Question 1: A patient with end-stage renal disease on hospice develops severe, refractory agitation. Which opioid is generally AVOIDED in this population due to toxic metabolite accumulation?
- Hydromorphone
- Fentanyl
- Morphine (Correct answer)
- Methadone
Correct answer: Morphine
Morphine's active metabolite morphine-6-glucuronide accumulates in renal failure and can cause neuroexcitatory effects including agitation, myoclonus, and seizures.
Question 2: The NURSE Act is relevant to palliative care nursing practice because it:
- Mandates hospice admission for all patients with six-month prognoses
- Provides a legal framework supporting nurses who advocate for adequate pain and symptom management (Correct answer)
- Requires nurses to report physicians who under-prescribe opioids
- Establishes the Medicare Hospice Benefit reimbursement structure
Correct answer: Provides a legal framework supporting nurses who advocate for adequate pain and symptom management
The NURSE Act (Nurses for the Understanding of Research, Science, and Education in pain management) supports nurses' advocacy for adequate pain treatment without fear of regulatory reprisal.
Question 3: A terminally ill patient states, 'I've been thinking about taking all my pills at once.' The nurse's FIRST priority is:
- Document the statement and notify the physician at the next scheduled visit
- Perform a thorough assessment of suicidal ideation including intent, plan, and access to means (Correct answer)
- Reassure the patient that things will improve with better pain management
- Immediately call 911 and send the patient to the emergency department
Correct answer: Perform a thorough assessment of suicidal ideation including intent, plan, and access to means
Any statement suggesting suicidal ideation requires immediate, thorough assessment of intent, plan, and means before determining the appropriate intervention.
Question 4: Palliative sedation for refractory suffering is ethically justified under which doctrine?
- Doctrine of Double Effect (Correct answer)
- Principle of Utility
- Rule of Rescue
- Substituted Judgment Standard
Correct answer: Doctrine of Double Effect
The Doctrine of Double Effect holds that an action intended to relieve suffering (sedation) is ethically permissible even if it may foreseeably hasten death as an unintended secondary effect.
Question 5: A patient on hospice is found to have a new, painful vertebral compression fracture. Which palliative intervention would MOST directly address the underlying cause of pain?
- Increase opioid dose only
- Palliative radiation therapy to the affected vertebra (Correct answer)
- Apply a rigid back brace and restrict mobility
- Refer for surgical spinal fusion
Correct answer: Palliative radiation therapy to the affected vertebra
Palliative radiation therapy is highly effective at reducing bone pain from metastatic disease by targeting the underlying cause, and is consistent with hospice comfort goals.
Question 6: Which of the following laboratory findings is MOST consistent with the expected physiologic changes of a patient in the final 24–48 hours of life?
- Elevated white blood cell count indicating infection
- Hyperglycemia due to reduced insulin sensitivity
- Progressive azotemia with rising BUN and creatinine (Correct answer)
- Thrombocytosis from bone marrow compensation
Correct answer: Progressive azotemia with rising BUN and creatinine
Rising BUN and creatinine (azotemia) reflect declining renal perfusion and function as part of the normal multi-organ shutdown that occurs in the final days of life.
Question 7: A hospice nurse is completing bereavement follow-up with a widow 14 months after her husband's death. The widow reports she still cannot accept the loss and is unable to function in daily life. This presentation is most consistent with:
- Normal acute grief reaction
- Anticipatory grief
- Prolonged grief disorder (complicated grief) (Correct answer)
- Major depressive disorder unrelated to bereavement
Correct answer: Prolonged grief disorder (complicated grief)
Prolonged grief disorder is characterized by persistent, debilitating grief lasting more than 12 months with inability to accept the loss and significant functional impairment.
CHPN MCQ Practice 5
A patient with end-stage renal disease on hospice develops severe, refractory agitation.
Which opioid is generally AVOIDED in this population due to toxic metabolite accumulation?