CHPN Pain Management Strategies 4

Question 1

A patient with end-stage renal disease requires opioid therapy. Which opioid is SAFEST to use in this population due to its metabolite profile?

Accepted Answer

Fentanyl

Answer

Fentanyl is the preferred opioid in renal failure because it has inactive metabolites that do not accumulate, unlike morphine or hydromorphone.

Question 2

A palliative nurse is preparing to titrate opioids in an opioid-naive patient with severe cancer pain. What is the standard starting oral morphine dose for adults?

Accepted Answer

5 mg every 4 hours

Answer

The standard starting dose of oral immediate-release morphine in opioid-naive adults is 5 mg every 4 hours, titrated based on response.

Question 3

Which statement best describes the principle of 'opioid rotation' in palliative care?

Accepted Answer

Switching to a different opioid when analgesia is inadequate or side effects are intolerable

Answer

Opioid rotation involves switching to a different opioid to improve the balance between analgesia and side effects, often using incomplete cross-tolerance to achieve better control.

Question 4

A nurse is managing a patient's pain with a transdermal fentanyl patch. The patient's pain acutely worsens after 60 hours. What is the most appropriate first action?

Accepted Answer

Administer an oral immediate-release opioid for breakthrough pain

Answer

When transdermal fentanyl does not control breakthrough or acute pain, an immediate-release opioid should be used for rescue while patch delivery continues.

Question 5

A patient receiving intrathecal opioid therapy for refractory pain reports sudden severe headache. What serious complication should the nurse suspect first?

Accepted Answer

Post-dural puncture headache or catheter migration

Answer

Sudden severe headache in an intrathecal catheter patient suggests post-dural puncture headache or catheter migration, requiring immediate assessment.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN Pain Management Strategies 4