CHPN Pain & Symptom Management 2

Question 1

A hospice patient on scheduled morphine reports breakthrough pain occurring 4-5 times daily. What is the most appropriate intervention?

Accepted Answer

Increase the scheduled around-the-clock morphine dose

Answer

Frequent breakthrough pain (>3-4 episodes/day) indicates the scheduled baseline dose is inadequate and should be titrated upward.

Question 2

Which adjuvant analgesic is first-line for neuropathic pain in hospice patients who can tolerate oral medications?

Accepted Answer

Gabapentin

Answer

Gabapentin (and pregabalin) are first-line adjuvants for neuropathic pain due to their efficacy and relative tolerability.

Question 3

A patient with hepatic metastases has ascites causing severe dyspnea and abdominal discomfort. Which intervention most directly addresses both symptoms?

Accepted Answer

Perform therapeutic paracentesis

Answer

Therapeutic paracentesis removes ascitic fluid, directly reducing intra-abdominal pressure and relieving both dyspnea and abdominal pain.

Question 4

When converting a patient from oral morphine 60 mg/day to IV morphine, what is the correct equianalgesic IV daily dose?

Accepted Answer

20 mg IV

Answer

The oral-to-IV morphine ratio is approximately 3:1, so 60 mg oral ÷ 3 = 20 mg IV per day.

Question 5

A hospice patient develops opioid-induced constipation. Which laxative regimen is most appropriate as first-line prophylaxis?

Accepted Answer

Stimulant laxative such as senna with or without a softener

Answer

Stimulant laxatives (senna) with or without docusate are recommended first-line prophylaxis for opioid-induced constipation in palliative patients.

(CHPN) Hospice Certified Professional Practice Test

(CHPN) Hospice Certified Professional Practice Test

CHPN Pain & Symptom Management 2