CHPN Non-Pain Symptom Management 3 — Questions and Answers
Question 1: A hospice patient reports nausea that worsens with movement and is accompanied by vertigo. Which antiemetic class is MOST appropriate for motion-related nausea?
- 5-HT3 antagonists (e.g., ondansetron)
- Antihistamines/anticholinergics (e.g., meclizine) (Correct answer)
- Prokinetics (e.g., metoclopramide)
- Corticosteroids (e.g., dexamethasone)
Correct answer: Antihistamines/anticholinergics (e.g., meclizine)
Antihistamines and anticholinergics target the vestibular system and are first-line for motion-induced or vestibular nausea.
Question 2: Which of the following is the MOST common cause of nausea and vomiting in patients with advanced cancer?
- Chemotherapy-induced emesis
- Opioid-induced nausea via the chemoreceptor trigger zone (CTZ) (Correct answer)
- Gastroparesis from vagal nerve compression
- Increased intracranial pressure
Correct answer: Opioid-induced nausea via the chemoreceptor trigger zone (CTZ)
Opioids stimulate dopamine receptors in the CTZ, making opioid-induced nausea one of the most frequent causes in palliative cancer patients.
Question 3: A patient with a malignant bowel obstruction is experiencing intractable vomiting. Which combination of medications is MOST appropriate for comfort?
- Metoclopramide and lactulose
- Haloperidol and octreotide (Correct answer)
- Ondansetron and metformin
- Dexamethasone and docusate
Correct answer: Haloperidol and octreotide
Haloperidol reduces nausea via CTZ blockade while octreotide decreases GI secretions, reducing vomiting volume in bowel obstruction.
Question 4: A hospice nurse is caring for a patient with opioid-induced constipation. The patient has been on scheduled morphine for 2 weeks with no bowel movement in 5 days. Which laxative is MOST appropriate?
- Bulk-forming agent (psyllium)
- Stimulant laxative (senna) combined with a stool softener (docusate) (Correct answer)
- Osmotic laxative alone (lactulose)
- Methylnaltrexone only
Correct answer: Stimulant laxative (senna) combined with a stool softener (docusate)
A stimulant laxative plus softener is the standard first-line regimen for opioid-induced constipation in palliative care.
Question 5: Methylnaltrexone (Relistor) is used in palliative care for which specific indication?
- Opioid-induced constipation refractory to conventional laxatives (Correct answer)
- Nausea caused by chemotherapy
- Opioid-induced respiratory depression
- Malignant bowel obstruction
Correct answer: Opioid-induced constipation refractory to conventional laxatives
Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that reverses opioid-induced constipation without affecting central analgesia.
Question 6: Which non-pharmacologic intervention has the STRONGEST evidence for reducing chemotherapy-related nausea and vomiting in palliative patients?
- Aromatherapy with lavender oil
- Acupressure at the P6 (Neiguan) point (Correct answer)
- Guided imagery
- Cold compresses to the forehead
Correct answer: Acupressure at the P6 (Neiguan) point
Acupressure at the P6 wrist point has the most consistent evidence among non-pharmacologic approaches for reducing nausea.
Question 7: A patient with advanced renal failure on hospice develops hiccups that have persisted for 3 days. Which medication is MOST commonly used to treat intractable hiccups in palliative care?
- Lorazepam
- Chlorpromazine or haloperidol (Correct answer)
- Metoclopramide
- Gabapentin
Correct answer: Chlorpromazine or haloperidol
Chlorpromazine is the only FDA-approved drug for hiccups; haloperidol is commonly used off-label with good evidence in palliative settings.
CHPN Non-Pain Symptom Management 3
A hospice patient reports nausea that worsens with movement and is accompanied by vertigo.
Which antiemetic class is MOST appropriate for motion-related nausea?