CHPN Pain & Symptom Management 3

Question 1

A terminally ill patient can no longer swallow oral medications. Which route is generally preferred for continuous opioid delivery in hospice?

Accepted Answer

Subcutaneous continuous infusion via CSCI

Answer

Subcutaneous continuous infusion (CSCI) via a syringe driver is preferred when the oral route is lost because it is minimally invasive, comfortable, and maintains steady drug levels.

Question 2

A patient's family asks why the nurse is giving morphine when the patient appears comfortable and is breathing slowly. What is the most accurate response?

Accepted Answer

Morphine controls pain and dyspnea; the dose is titrated to comfort, not to respiratory rate

Answer

Opioids are titrated to symptom control; slow respirations near death are a sign of the dying process, not opioid toxicity, when doses are appropriately titrated.

Question 3

Which symptom cluster is most characteristic of opioid toxicity in a hospice patient?

Accepted Answer

Myoclonus, confusion, and pinpoint pupils

Answer

Opioid toxicity classically presents with myoclonus, delirium/confusion, and miosis (pinpoint pupils), often prompting opioid rotation.

Question 4

When is opioid rotation (switching to a different opioid) most indicated in palliative care?

Accepted Answer

When pain is uncontrolled despite dose escalation or intolerable side effects develop

Answer

Opioid rotation is indicated for inadequate analgesia despite escalation or for intolerable side effects, using equianalgesic dosing with a 25-30% reduction for incomplete cross-tolerance.

Question 5

A hospice patient reports that her pain is a 3/10 at rest but spikes to 8/10 with repositioning. This is best classified as:

Accepted Answer

Incident (movement-related) breakthrough pain

Answer

Pain that is predictably triggered by a specific activity like repositioning is classified as incident breakthrough pain, a subtype of breakthrough pain.

(CHPN) Hospice Certified Professional Practice Test

(CHPN) Hospice Certified Professional Practice Test

CHPN Pain & Symptom Management 3