CHPN Pain Management Strategies 2

Question 1

A hospice patient on long-acting morphine reports breakthrough pain occurring 5-6 times per day. What is the most appropriate intervention?

Accepted Answer

Increase the long-acting opioid dose

Answer

Frequent breakthrough pain (more than 3-4 episodes/day) indicates the baseline long-acting opioid dose is inadequate and should be increased.

Question 2

Which equianalgesic conversion is correct when rotating from oral morphine 60 mg/day to oral oxycodone?

Accepted Answer

40 mg oxycodone/day

Answer

The standard equianalgesic ratio of oral morphine to oral oxycodone is approximately 1.5:1, so 60 mg morphine converts to roughly 40 mg oxycodone per day.

Question 3

A palliative care nurse is assessing a patient with neuropathic pain unresponsive to opioids alone. Which adjuvant is first-line for this pain type?

Accepted Answer

Gabapentin

Answer

Gabapentin (and pregabalin) are first-line adjuvant analgesics for neuropathic pain in palliative care.

Question 4

When calculating an appropriate breakthrough opioid dose, what percentage of the total daily opioid dose should typically be used?

Accepted Answer

10-15%

Answer

Breakthrough doses are standardly calculated as 10-15% of the total daily opioid dose, administered every 1-4 hours as needed.

Question 5

A patient with bone metastases has pain well-controlled at rest but reports severe movement-related (incident) pain. What intervention most specifically targets incident pain?

Accepted Answer

Administering a rapid-onset opioid 20-30 minutes before activity

Answer

Rapid-onset opioids given prophylactically before anticipated painful activities are the standard approach to incident (movement-related) pain.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN Pain Management Strategies 2