CPNRE - Canadian Practical Nurse Registration Examination Gerontological and Palliative Care Questions and Answers Flashcards

A 78-year-old resident with moderate dementia and heart failure is admitted to palliative care. The care team notes she occasionally states 'I want to go home' but her family insists she cannot make decisions. Under the CPNRE framework, what is the practical nurse's PRIMARY responsibility regarding this resident's expressed wishes?

Answer: Document the statements as evidence of decisional capacity and initiate a formal capacity assessment referral

A dementia diagnosis does not automatically negate decisional capacity — capacity is decision-specific and time-specific. The resident's repeated expressed wish to go home constitutes meaningful communication that must be documented and evaluated. The practical nurse's duty is to advocate for the resident by ensuring a formal capacity assessment is initiated, not to override her voice based solely on a diagnosis or family preference.

During end-of-life care, an 84-year-old man on a continuous subcutaneous morphine infusion for pain management develops Cheyne-Stokes respirations, mottled skin to the knees, and is unresponsive. His daughter arrives and insists the nurse increase the morphine dose to 'speed things up.' What is the most appropriate nursing response?

Answer: Explain that the current infusion is titrated for comfort and that hastening death intentionally falls outside the nurse's scope; offer to facilitate a palliative care physician consult

Intentionally hastening death at a family member's request — rather than for symptom relief — falls outside nursing scope and is ethically distinct from palliative sedation titrated for comfort. The nurse must uphold the doctrine of double effect while clearly explaining the distinction, declining to act outside scope, and facilitating appropriate medical consultation. Adjusting the dose for non-clinical reasons, in either direction, is inappropriate.

A 91-year-old long-term care resident with advanced COPD, osteoporosis, and cognitive impairment has a valid advance directive refusing intubation and CPR. During a night shift, she develops acute respiratory distress and her son — who holds power of attorney for personal care — demands 'do everything possible.' Which action by the practical nurse is MOST appropriate?

Answer: Follow the advance directive as written; the POA for personal care cannot override a competently-executed prior directive that addresses this specific situation

A validly executed advance directive that specifically addresses the clinical situation (intubation/CPR refusal) takes precedence. A substitute decision-maker must honour the previously expressed capable wishes of the individual — they do not have authority to override a specific prior refusal. The nurse should provide comfort measures (oxygen, positioning, anxiolytics as ordered), follow the directive, and notify the physician and supervisor while supporting the family through the process.

A practical nurse is caring for an 80-year-old woman in palliative care who has not eaten or drunk anything for 5 days. The family requests IV hydration, believing dehydration is causing her suffering. Current evidence in palliative gerontological nursing most accurately supports which position?

Answer: Terminal dehydration in the final days of life does not typically increase suffering and may reduce respiratory secretions and urinary incontinence; IV fluids can sometimes increase discomfort

Evidence-based palliative care literature consistently shows that terminal dehydration in the active dying phase does not typically cause distress and is part of the normal dying process. Parenteral fluids can increase pulmonary secretions (death rattle), peripheral edema, and ascites — potentially worsening comfort. The nurse's role is to educate the family compassionately, ensure good oral care, and advocate for a goals-of-care discussion with the palliative team.

A 76-year-old man with vascular dementia in a long-term care facility consistently resists morning personal care by hitting and shouting. Staff have tried explaining each step; the behaviour persists. Which advanced gerontological nursing intervention is MOST likely to reduce this responsive behaviour while maintaining dignity?

Answer: Implement a consistent, individualized care routine using the resident's preferred sensory cues (music, familiar phrases, preferred caregiver) and break care into shorter intervals aligned with his calm periods

Responsive behaviours in dementia are communication — the resident is expressing unmet needs, fear, or pain. Person-centred, non-pharmacological strategies are the evidence-based first line: leveraging preserved long-term memory cues, preferred caregivers, music therapy, and restructuring care timing to match the resident's calm periods. Chemical or physical restraints are ethically and clinically contraindicated as first-line responses and are associated with serious adverse outcomes in older adults.

A palliative care nurse is assessing pain in an 88-year-old resident with end-stage renal disease, severe expressive aphasia following a stroke, and opioid therapy. The resident's serum creatinine has risen sharply. Which pharmacological concern is MOST critical for the practical nurse to flag to the prescribing team?

Answer: Accumulation of morphine-6-glucuronide, an active metabolite that cannot be renally cleared, increasing the risk of opioid neurotoxicity including myoclonus and hyperalgesia

Morphine-6-glucuronide (M6G) is a pharmacologically active metabolite of morphine that is renally excreted. In end-stage renal disease, M6G accumulates and crosses the blood-brain barrier, producing opioid neurotoxicity — clinically manifested as myoclonus, allodynia, hyperalgesia, and seizures — rather than classic opioid overdose. The practical nurse must recognize this risk and escalate to the team, as an opioid rotation (e.g., to hydromorphone with dose reduction) is often warranted.