CHPN Non-Pain Symptom Management 2 — Questions and Answers
Question 1: A hospice patient with advanced COPD reports severe air hunger despite being on low-flow oxygen. Which intervention is MOST effective for relieving dyspnea in this patient?
- Increase oxygen flow to 6 L/min
- Administer low-dose oral morphine (Correct answer)
- Start a nebulized bronchodilator every hour
- Apply a nonrebreather mask
Correct answer: Administer low-dose oral morphine
Low-dose opioids such as morphine are the most evidence-based pharmacologic treatment for refractory dyspnea in palliative patients.
Question 2: Which of the following best describes the mechanism by which a bedside fan helps relieve dyspnea in palliative care patients?
- It increases oxygen delivery to the alveoli
- It stimulates trigeminal nerve receptors, reducing breathlessness perception (Correct answer)
- It lowers core body temperature, reducing oxygen demand
- It humidifies inspired air, decreasing airway resistance
Correct answer: It stimulates trigeminal nerve receptors, reducing breathlessness perception
Cool airflow directed at the face stimulates trigeminal receptors and reduces the central perception of breathlessness.
Question 3: A dying patient develops noisy, gurgling respirations ('death rattle'). The family is distressed. What is the PRIORITY nursing intervention?
- Suction the oropharynx to clear secretions
- Administer IV furosemide to reduce fluid overload
- Educate the family that the patient is not suffering and reposition the patient (Correct answer)
- Increase IV fluid rate to thin secretions
Correct answer: Educate the family that the patient is not suffering and reposition the patient
Death rattle is caused by pooled secretions the patient can no longer clear; family education and repositioning are first-line because the patient is typically unconscious and not distressed.
Question 4: Which anticholinergic medication is commonly used to reduce excessive respiratory secretions ('death rattle') near end of life?
- Haloperidol
- Glycopyrrolate (Correct answer)
- Metoclopramide
- Lorazepam
Correct answer: Glycopyrrolate
Glycopyrrolate is an anticholinergic that reduces secretion production without crossing the blood-brain barrier, minimizing CNS side effects.
Question 5: A hospice patient with advanced cancer develops massive hemoptysis. What is the MOST appropriate immediate nursing action?
- Elevate the head of the bed and call 911
- Position the patient with the bleeding lung dependent and administer sedation (Correct answer)
- Apply pressure to the chest and increase oxygen flow
- Encourage deep coughing to clear the airway
Correct answer: Position the patient with the bleeding lung dependent and administer sedation
Positioning the affected lung down prevents blood from flooding the contralateral lung, and sedation (e.g., midazolam) provides comfort during this terminal event.
Question 6: When assessing dyspnea in a nonverbal palliative care patient, which tool is MOST appropriate?
- Numeric Rating Scale (NRS)
- Respiratory Distress Observation Scale (RDOS) (Correct answer)
- Modified Borg Scale
- Visual Analog Scale (VAS)
Correct answer: Respiratory Distress Observation Scale (RDOS)
The RDOS uses observable behavioral and physiologic indicators to quantify respiratory distress in patients who cannot self-report.
Question 7: A patient on hospice for end-stage heart failure has refractory dyspnea and peripheral edema. The family asks why diuretics have been discontinued. What is the BEST response?
- Diuretics are contraindicated in heart failure near end of life
- At this stage, the burden of diuresis often outweighs the benefit and comfort-focused opioids are more effective (Correct answer)
- Diuretics cause kidney failure and were stopped to protect remaining organ function
- Diuretics are too expensive for hospice to cover
Correct answer: At this stage, the burden of diuresis often outweighs the benefit and comfort-focused opioids are more effective
Near end of life, the discomfort of frequent urination, electrolyte monitoring, and minimal clinical benefit often makes discontinuing diuretics the most compassionate choice.
CHPN Non-Pain Symptom Management 2
A hospice patient with advanced COPD reports severe air hunger despite being on low-flow oxygen.
Which intervention is MOST effective for relieving dyspnea in this patient?