CHPN Non-Pain Symptom Management 5 — Questions and Answers
Question 1: A hospice patient reports severe fatigue that is not relieved by rest. Which intervention has the STRONGEST evidence for cancer-related fatigue in palliative patients?
- High-dose vitamin B12 supplementation
- Graded exercise therapy tailored to the patient's tolerance (Correct answer)
- Routine blood transfusions
- Stimulant medications such as methylphenidate
Correct answer: Graded exercise therapy tailored to the patient's tolerance
Graded exercise therapy has the strongest evidence base for reducing cancer-related fatigue and improving function even in advanced illness.
Question 2: A terminally ill patient with severe cachexia asks about appetite stimulants. Which medication has evidence for improving appetite and weight in palliative patients?
- Ondansetron
- Megestrol acetate (Correct answer)
- Metoclopramide
- Furosemide
Correct answer: Megestrol acetate
Megestrol acetate (a progestational agent) improves appetite and may lead to modest weight gain in palliative patients with cachexia-anorexia syndrome.
Question 3: A hospice nurse is caring for a patient with fungating wound odor causing significant distress. Which intervention MOST effectively addresses malodor?
- Increase dressing frequency to every 2 hours
- Apply topical metronidazole gel to the wound (Correct answer)
- Cover the wound with activated charcoal dressings only
- Irrigate with hydrogen peroxide three times daily
Correct answer: Apply topical metronidazole gel to the wound
Topical metronidazole targets the anaerobic bacteria responsible for malodor in fungating wounds and is well-supported by evidence.
Question 4: Which of the following BEST describes the pathophysiology of pruritus (itching) in a hospice patient with advanced cholestatic liver disease?
- Histamine release from mast cells in the dermis
- Accumulation of bile salts in the skin stimulating cutaneous nerve endings (Correct answer)
- Opioid-induced peripheral sensitization
- Dehydration causing skin dryness
Correct answer: Accumulation of bile salts in the skin stimulating cutaneous nerve endings
In cholestatic disease, retained bile salts deposit in the skin and directly stimulate pruritic nerve fibers, often requiring agents beyond antihistamines.
Question 5: A patient with advanced cancer on morphine develops opioid-induced pruritus. Which intervention is MOST appropriate?
- Discontinue all opioids immediately
- Administer a low-dose opioid antagonist such as nalbuphine or consider opioid rotation (Correct answer)
- Start diphenhydramine scheduled around the clock
- Apply topical hydrocortisone to the entire body
Correct answer: Administer a low-dose opioid antagonist such as nalbuphine or consider opioid rotation
Opioid rotation can reduce pruritus by switching to an agent with less histamine release; low-dose nalbuphine (mixed agonist-antagonist) can also relieve opioid-induced itch.
Question 6: A hospice patient with advanced dementia cannot report symptoms. Which scale is MOST appropriate to assess their overall comfort?
- Karnofsky Performance Scale
- Palliative care Outcome Scale (POS)
- Discomfort Scale for Dementia of the Alzheimer Type (DS-DAT) (Correct answer)
- Edmonton Symptom Assessment System (ESAS)
Correct answer: Discomfort Scale for Dementia of the Alzheimer Type (DS-DAT)
The DS-DAT is specifically validated to assess discomfort in patients with severe dementia who cannot self-report, using observable behavioral cues.
Question 7: A hospice nurse notices a patient with a stage 3 pressure injury over the sacrum. The patient is bed-bound and cachectic. Which wound care goal MOST aligns with palliative principles?
- Achieve complete wound healing within 4 weeks using aggressive debridement
- Prioritize comfort, odor control, and infection prevention over wound closure (Correct answer)
- Apply growth factor therapy to stimulate tissue regeneration
- Consult vascular surgery for possible skin grafting
Correct answer: Prioritize comfort, odor control, and infection prevention over wound closure
In palliative care, wound management goals shift from healing to comfort, quality of life, and symptom control when healing is not achievable.
CHPN Non-Pain Symptom Management 5
A hospice patient reports severe fatigue that is not relieved by rest.
Which intervention has the STRONGEST evidence for cancer-related fatigue in palliative patients?