Free ACHPN Intervention and Management Questions and Answers — Questions and Answers
Question 1: A patient complains of inability to sleep because of persistent severe restless legs syndrome. Which of the following medications is most indicated?
- Pramipexole (Correct answer)
- Levo-dopa
- Cabergoline
- Gabapentin
Correct answer: Pramipexole
Explanation: <br> While various drugs have been used to treat restless legs syndrome, drugs that are FDA-approved for RLS and that are usually well-tolerated are pramipexole (Mirapex®) and Ropinirole (Requip®). The initial dose of pramipexole is usually 0.25 mg PO 2-3 hours before bedtime with dosage increased in 4-7 days if needed. Levo-dopa sometimes causes worsening of symptoms over time. Cabergoline is associated with severe adverse effects, and gabapentin may provide some relief of mild to moderate RLS but is associated with numerous adverse effects as well.
Question 2: The factor that most indicates a risk of drug abuse or misuse after beginning chronic opioid therapy is:
- severe pain.
- older age
- preexisting cognitive impairment.
- personal/family history of substance abuse. (Correct answer)
Correct answer: personal/family history of substance abuse.
Explanation: <br> The factor that most indicates a risk of drug abuse or misuse after beginning chronic opioid therapy is personal/family history of substance abuse. Patients with this history should be educated thoroughly about risks and monitored carefully. Other risk factors for abuse or misuse include a younger age and psychiatric comorbidity.
Question 3: For which of the following diagnoses may a patient be eligible for hospice care on diagnosis if the patient chooses to forego treatment?
- Leukemia
- Small cell lung cancer (Correct answer)
- Amyotrophic lateral sclerosis
- Multiple myeloma
Correct answer: Small cell lung cancer
Explanation: <br> A patient may be eligible for hospice care on diagnosis of small cell lung cancer if the patient chooses to forego treatment because the prognosis is so poor and the average life expectancy is about 2-3 months. Other diagnoses that also may make a patient foregoing treatment eligible include pancreatic cancer, which results in a life expectancy of 4-8 months, and brain tumors (such as glioblastoma multiforme) with a life expectancy of about 6-8 months.
Question 4: An 80-year-old non-diabetic patient with renal failure who has refused hemodialysis and is not a candidate for kidney transplantation has requested hospice services. Which of the following laboratory findings supports admission to hospice?
- Creatinine clearance <10 mL/min and serum creatinine >8.0 mg/dL. (Correct answer)
- Creatinine clearance <15 mL/min and serum creatinine >7.0 mg/dL.
- Creatinine clearance <15 mL/min and serum creatinine >6.0 mg/dL.
- Creatinine clearance <10 mL/min and serum creatinine >4 mg/dL.
Correct answer: Creatinine clearance <10 mL/min and serum creatinine >8.0 mg/dL.
Explanation: <br> If an 80-year-old non-diabetic patient with renal failure who has refused hemodialysis and is not a candidate for kidney transplantation has requested hospice services, the laboratory findings that support admission to hospice are creatinine clearance < 10 mL/min and serum creatinine >8.0 mg/dL. Requirements for diabetic patients with renal failure are slightly different: creatinine clearance <15 mL/min and serum creatinine >6.0 mg/dL. The patient must also have documentation that outlines signs and symptoms consistent with chronic or acute renal failure.
Question 5: A patient with AIDS has a CD4+ count of 24, a viral load of 110,000, and a 35% drop in lean body mass. The Karnofsky Performance Scale score needed to qualify the patient for hospice care is:
- <70.
- <60.
- <50. (Correct answer)
- <40.
Correct answer: <50.
Explanation: <br> If a patient with AIDS has a CD4+ count of 24, a viral load of 110,000, and a 35% drop in weight, the Karnofsky Performance Scale score needed to qualify the patient for hospice care is less than 50, which indicates that the patient is in need of assistance with activities of daily living and requires frequent medical care. The KPS classifies patients according to their functional ability, and a low score indicates a low chance of survival.
Question 6: A 46-year-old male with HIV/AIDS has anorexia and marked weight loss. Which of the following drugs may be indicated to relieve nausea and improve appetite?
- Dronabinol (Correct answer)
- Haloperidol
- Compazine
- Metoclopramide
Correct answer: Dronabinol
Explanation: <br> If a 46-year-old male with HIV/AIDS has anorexia and marked weight loss, the drug that is indicated to relieve nausea and improve appetite is dronabinol. The usual initial dosage for adults is 2.5 mg PO before lunch and dinner or 2.5 mg PO in a single dose in the evening. The dosage may be gradually increased to 20 mg daily in divided doses if necessary. Dronabinol is a cannabinoid and is also used to relieve chemotherapy-associated nausea and vomiting.
Question 7: Following a stroke, a patient had progressed well but has become increasingly unwilling to carry out exercises or participate in activities of daily living. The patient has not joined in any activities in the unit and increasingly stays in her room with the blinds drawn. These observations are probably an indication of:
- small strokes.
- dementia
- depression. (Correct answer)
- boredom.
Correct answer: depression.
Explanation: <br> If, following a stroke, a patient had progressed well but has become increasingly unwilling to carry out exercises or participate in activities of daily living, and the patient has not joined in any activities in the unit and increasingly stays in her room with the blinds drawn, these observations may likely be an indication of depression. Depression is common in those with chronic disease, especially if the disease involves disabilities that limit mobility.
Question 8: A hospice patient has increasing episodes of dyspnea, especially after exertion. The position of comfort that is most likely to reduce the dyspnea is:
- lying in bed with the head of the bed elevated to 45°.
- sitting upright in a chair with arms hanging loosely to the sides.
- leaning slightly forward in a chair with arms supported. (Correct answer)
- leaning back in a recliner chair.
Correct answer: leaning slightly forward in a chair with arms supported.
Explanation: <br> If a hospice patient has increasing episodes of dyspnea, especially after exertion, the position of comfort that is most likely to reduce the dyspnea is sitting in a chair and leaning slightly forward with the arms supported. The patient should be encouraged to take slow even breaths. Relaxation exercises may help the patient to breathe more slowly. A fan directed at the patient's face may help the patient to feel less anxious. Some patients may need oxygen for exertion if dyspnea is severe.
Question 9: A patient with peripheral edema and venous ulcers may benefit from an Unna's boot. Which of the following is a contraindication for application of the Unna's boot?
- Diabetes mellitus
- Peripheral arterial disease
- Ambulatory status
- Bedbound status (Correct answer)
Correct answer: Bedbound status
Explanation: <br> A contraindication to the application of the Unna's boot, which is a compression therapy, is bedbound status because the purpose of the boot is to apply support to the muscles of the calf when the patient ambulates. Unna's boot may be used if the patient has peripheral arterial disease and/or diabetes. Impregnated gauze (commonly zinc oxide or glycerin) is wrapped around the foot and lower leg and allowed to dry and covered with a self-adherent wrapping.
Question 10: If a patient with chronic bowel disease has developed persistent diarrhea, the treatment most indicated to control the diarrhea is:
- loperamide. (Correct answer)
- codeine.
- diphenoxylate.
- methylcellulose.
Correct answer: loperamide.
Explanation: <br> If a patient with chronic bowel disease has developed persistent diarrhea, the treatment most indicated to control the diarrhea is loperamide, which is indicated for nonspecific diarrhea but should be avoided if the patient has grossly bloody stool or temperature above 38° C (101° F) or if infection with C. difficile or Shigella is suspected. Loperamide is usually given at 4 mg initially followed by 2 mg after each loose stool to a total of 16 mg per day.
Question 11: An obese patient with diabetes mellitus who underwent surgery for bowel obstruction 6 days previously and has had persistent abdominal distention and episodes of nausea and vomiting indicates a desire for palliative care. The patient complains of feeling a "popping" sensation at the incision site, and the advanced practice registered nurse notes a large amount of serosanguinous drainage on the dressing and separation at the center of the incision line with beginning intestinal evisceration. The initial response should be to:
- administer an opioid and keep the patient comfortable with no further intervention.
- place the patient in a semi-Fowler's position with knees elevated and notify the surgeon. (Correct answer)
- explain to the patient what is happening and ask for guidance.
- place the patient in a supine position and cover the wound with dry sterile gauze.
Correct answer: place the patient in a semi-Fowler's position with knees elevated and notify the surgeon.
Explanation: <br> If a patient who has indicates a desire for palliative care complains of feeling a "popping" sensation at an abdominal incision site, and the advanced practice registered nurse notes a large amount of serosanguinous drainage on the dressing and separation at the center of the incision line with beginning intestinal evisceration, the initial response should be to place the patient in semi-Fowler's position, notify the surgeon, cover the wound with sterile saline-soaked gauze, start an IV line, and administer oxygen. Palliative care does not preclude responding to emergent changes in condition.
Free ACHPN Intervention and Management Questions and Answers
A patient complains of inability to sleep because of persistent severe restless legs syndrome.
Which of the following medications is most indicated?