CHPN Study Guide 3

Question 1

A CHPN notes that a patient on 60 mg oral morphine every 4 hours is requesting breakthrough doses every 2 hours. What is the MOST appropriate next step?

Accepted Answer

Notify the physician to reassess and consider increasing the scheduled opioid dose

Answer

Frequent breakthrough dose use (more than 3 times in 24 hours) indicates inadequate baseline analgesia and the scheduled dose should be titrated up.

Question 2

Which of the following is a key component of a Goals of Care conversation in palliative nursing?

Accepted Answer

Eliciting the patient's values, fears, and understanding of their illness

Answer

Goals of Care conversations are patient-centered and require eliciting values, prognosis understanding, and personal fears to guide care planning.

Question 3

A hospice patient with COPD develops increased dyspnea. After ruling out reversible causes, the MOST evidence-based pharmacologic intervention is:

Accepted Answer

Low-dose opioids (e.g., oral morphine 5 mg q4h)

Answer

Low-dose opioids are the gold standard for managing refractory dyspnea in palliative care patients.

Question 4

The Kübler-Ross model of grief includes five stages. Which stage is characterized by the patient attempting to negotiate with a higher power or medical team?

Accepted Answer

Bargaining

Answer

Bargaining is the stage where patients attempt to negotiate (e.g., 'If I can just live to see my grandchild born...') as a way of coping with loss.

Question 5

Which medication is the FIRST-LINE treatment for death rattle (noisy secretions) in the actively dying patient?

Accepted Answer

Glycopyrrolate or hyoscine (scopolamine)

Answer

Anticholinergic agents like glycopyrrolate or scopolamine reduce secretion production and are first-line for death rattle.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN Study Guide 3