CHPN Non-Pain Symptom Management 4

Question 1

A terminally ill patient is experiencing agitated delirium with hallucinations and combativeness. Which medication is FIRST-LINE for managing hyperactive delirium in hospice?

Accepted Answer

Haloperidol (antipsychotic)

Answer

Haloperidol is the first-line agent for hyperactive delirium in palliative care due to its efficacy in reducing psychotic symptoms with minimal sedation.

Question 2

Which of the following is a REVERSIBLE cause of delirium that should be assessed in a hospice patient experiencing acute confusion?

Accepted Answer

Urinary retention or fecal impaction

Answer

Urinary retention and fecal impaction are common, treatable causes of delirium in palliative patients that should be assessed before attributing confusion to disease progression.

Question 3

A patient in the last days of life develops terminal restlessness unresponsive to haloperidol. What is the NEXT appropriate intervention?

Accepted Answer

Add a benzodiazepine such as midazolam for refractory agitation

Answer

Midazolam is added for refractory terminal restlessness when haloperidol alone is insufficient, providing anxiolysis and sedation.

Question 4

When educating a family about terminal delirium, which statement BEST reflects evidence-based understanding?

Accepted Answer

Delirium is common near death and may represent a transitional state; the patient is often unaware of their behavior

Answer

Terminal delirium is a normal part of the dying process; patients are typically unaware of their behavior, and families need reassurance that it does not mean suffering.

Question 5

A hospice patient on chronic opioids develops myoclonus (muscle twitching). Which is the MOST likely cause?

Accepted Answer

Accumulation of opioid metabolites, particularly morphine-6-glucuronide

Answer

Opioid-induced myoclonus results from accumulation of neuroexcitatory metabolites (e.g., morphine-3-glucuronide) especially in renal impairment.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN Non-Pain Symptom Management 4