CHPN Study Guide 4 — Questions and Answers
Question 1: Which symptom cluster is MOST commonly associated with opioid toxicity in a palliative care patient?
- Diarrhea, hypertension, and tachycardia
- Myoclonus, cognitive changes, and hyperalgesia (Correct answer)
- Bradycardia, hypotension, and diaphoresis
- Nausea, constipation, and pruritis only
Correct answer: Myoclonus, cognitive changes, and hyperalgesia
Opioid-induced neurotoxicity (OIN) presents as myoclonus, delirium/cognitive changes, and paradoxical hyperalgesia, often requiring opioid rotation.
Question 2: Under the Medicare Hospice Benefit, what is the maximum number of days allowed for respite care per respite period?
- 3 consecutive days
- 5 consecutive days (Correct answer)
- 7 consecutive days
- 14 consecutive days
Correct answer: 5 consecutive days
Medicare allows up to 5 consecutive days of inpatient respite care per respite period to give caregivers a temporary break.
Question 3: A nurse caring for a dying patient notes the family is praying continuously and refuses to discuss the patient's decline. The culturally competent response is to:
- Insist on a family meeting to discuss the prognosis immediately
- Respect the family's spiritual coping and gently offer to be present when they are ready to discuss care (Correct answer)
- Document that the family is in denial and refer to social work only
- Limit visiting hours to reduce family stress
Correct answer: Respect the family's spiritual coping and gently offer to be present when they are ready to discuss care
Culturally competent care means respecting spiritual practices as coping mechanisms while remaining available for discussion without forcing it.
Question 4: When titrating subcutaneous morphine for a patient who can no longer swallow, what is the equianalgesic conversion ratio for oral to subcutaneous morphine?
- 1:1 (oral to subcutaneous)
- 3:1 (oral to subcutaneous) (Correct answer)
- 2:1 (oral to subcutaneous)
- 1:2 (oral to subcutaneous)
Correct answer: 3:1 (oral to subcutaneous)
The conversion ratio is approximately 3:1 (oral to subcutaneous), meaning the subcutaneous dose is one-third of the oral dose.
Question 5: Which intervention is MOST effective for managing anticipatory nausea in a palliative care patient receiving opioids?
- Withholding the next opioid dose
- Scheduled antiemetics with reassessment and treating the underlying cause (Correct answer)
- Restricting fluid intake to reduce gastric volume
- Switching immediately to an alternative opioid without antiemetics
Correct answer: Scheduled antiemetics with reassessment and treating the underlying cause
Scheduled antiemetics address opioid-induced nausea, and identifying the mechanism guides selection of the most appropriate agent.
Question 6: A CHPN is educating a new nurse about the principle of double effect. Which scenario BEST illustrates this principle?
- Administering a lethal dose of morphine with the intent to end the patient's life
- Giving adequate morphine for pain relief knowing it may secondarily depress respiration, with pain relief as the intent (Correct answer)
- Withholding opioids to avoid respiratory depression
- Using sedation with the primary goal of hastening the patient's death
Correct answer: Giving adequate morphine for pain relief knowing it may secondarily depress respiration, with pain relief as the intent
The principle of double effect holds that an action with a good intended effect (pain relief) is ethically permissible even if it risks a foreseeable but unintended bad effect (respiratory depression).
Question 7: A hospice patient with terminal cancer develops hypercalcemia. Which symptom would the nurse MOST likely assess?
- Hyperreflexia and muscle spasms
- Confusion, polyuria, nausea, and constipation (Correct answer)
- Hypotension and bradycardia exclusively
- Peripheral edema and weight gain
Correct answer: Confusion, polyuria, nausea, and constipation
Hypercalcemia of malignancy classically presents with confusion, polyuria, nausea, constipation, and lethargy (bones, moans, groans, psychic overtones).
CHPN Study Guide 4
Which symptom cluster is MOST commonly associated with opioid toxicity in a palliative care patient?