CHPN Pain & Symptom Management 4

Question 1

A hospice patient with advanced dementia cannot self-report pain. Which validated tool is most appropriate for assessing pain in this population?

Accepted Answer

PAINAD (Pain Assessment in Advanced Dementia)

Answer

The PAINAD scale assesses pain through observable behaviors (breathing, vocalization, facial expression, body language, consolability) in patients who cannot self-report.

Question 2

Terminal secretions ('death rattle') in a dying patient are best managed initially with:

Accepted Answer

Repositioning and anticholinergic medications such as glycopyrrolate

Answer

Repositioning and anticholinergic agents (glycopyrrolate, hyoscine) reduce secretion production and are the standard initial management for terminal secretions.

Question 3

A patient on a fentanyl transdermal patch develops fever. What clinical concern does this raise regarding pain management?

Accepted Answer

Fever increases transdermal fentanyl absorption, potentially causing toxicity

Answer

Fever increases skin blood flow and temperature, accelerating transdermal fentanyl absorption and raising the risk of opioid toxicity.

Question 4

Which statement about methadone use in hospice is most accurate?

Accepted Answer

Methadone's long and variable half-life requires careful titration and monitoring

Answer

Methadone's unpredictable and prolonged half-life (8-80+ hours) risks accumulation and delayed toxicity, requiring careful titration by experienced clinicians.

Question 5

A hospice patient is experiencing refractory nausea despite ondansetron. She has nausea triggered by movement and position changes. Which antiemetic class is most appropriate to add?

Accepted Answer

Anticholinergics such as scopolamine

Answer

Movement-triggered nausea (vestibular origin) is best treated with anticholinergic agents like scopolamine, which act on the vestibular system.

(CHPN) Hospice Certified Professional Practice Test

(CHPN) Hospice Certified Professional Practice Test

CHPN Pain & Symptom Management 4