Free Certified Hospice and Palliative Nurse Questions and Answers — Questions and Answers
Question 1: Which patient is most likely to not receive adequate care for their pain symptoms?
- 51-year old male, recently diagnosed with ALS; a former weight lifter
- 42-year old female with early-onset dementia, living with her sister.
- 86-year old female with COPD, living in an assisted living facility (Correct answer)
- 74-year old male with congestive heart failure, living with his wife
Correct answer: 86-year old female with COPD, living in an assisted living facility
Contrary to popular belief, under-treatment of pain is more likely to occur in older people, people of color, and women than in younger individuals with fewer co-morbidities. The 86-year-old possesses two of the three risk variables for each of the four case studies.
Question 2: What other medications must to be taken along with any opioid regimen?
- Senna (Correct answer)
- Pamidronate
- Ondansetron
- Diphenhydramine
Correct answer: Senna
Any patient using an opioid should also be prescribed a prophylactic bowel regimen to avoid or treat constipation, as it is one of the major side effects of opioid therapy. Senna is a laxative stimulant that increases bowel movement by chemically stimulating the gut. Diphenhydramine is an antihistamine used to treat opioid-induced pruritus, ondansetron HCl is a 5-HT3 receptor antagonist used to prevent nausea and vomiting, and pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain.
Question 3: Draco uses a short-acting prn opioid for breakthrough pain in addition to taking continuous-release morphine every 12 hours for pain management. At 9–10 hours, he is having end-of-dose failure. What would be the best course of action to treat Draco's discomfort?
- An adjuvant therapy such as a corticosteroid should be added.
- Draco should be switched to an equianalgesic alternative opioid
- The dosing interval of the continuous-release morphine should be decreased to every 8 hours, at the same dose, with no change in the prn dosing (Correct answer)
- The dose should be decreased every 12 hours, but the short-acting prn dose should be increased by 25%.
Correct answer: The dosing interval of the continuous-release morphine should be decreased to every 8 hours, at the same dose, with no change in the prn dosing
End-of-dose failure in Draco means that the blood levels of the medication are dropping in the final hours of the dosage cycle before the body absorbs the next dose as planned. Breakthrough pain, which is defined by an episode of agony despite control of ongoing baseline pain, is not the same as this. Jordan will have more consistent drug blood levels thanks to a shorter round-the-close drug interval. A short-acting bolus immediately before the next dosing cycle would only be produced by increasing the prn dose, and this could result in drowsiness and other adverse effects. It is not required to transition to another opioid because this is often done because of a negative side effect. In the last hours of the dosing cycle, a corticosteroid would not produce the desired pain control outcome.
Question 4: Which of the following could point to a bad prognosis for a hospice patient with an end-stage cardiac condition?
- Unexplained syncope (Correct answer)
- Infection
- Edema
- Bleeding
Correct answer: Unexplained syncope
Indicators of a poor prognosis in this patient population include unexplained syncope, prior cardiac arrest with resuscitation, and an embolic stroke originating from the cardiac system.
Question 5: Which of the following is a crucial component of supporting the patient's care needs when a hospice patient is dealing with growing weakness, exhaustion, and decreasing mobility?
- Honoring the wishes of family members
- Remaining as mobile as possible
- Seeing as many visitors as possible
- Prioritizing energy use (Correct answer)
Correct answer: Prioritizing energy use
Supporting the hospice patient who is progressively weaker and more exhausted requires prioritizing energy consumption. Giving the patient the tools to prioritize their physical, emotional, and spiritual needs will enable them to focus their limited resources on the areas that are most important to them.
Question 6: Jenny's pleural effusion is being intermittently drained using an indwelling pleural catheter. The nurse is on hand to instruct patients on how to use the catheter at home. Which aspect must the nurse emphasize to Jenny in order for her to avoid vasovagal symptoms?
- The catheter can only be accessed by a nurse.
- The drainage should occur slowly and continuously over an 8-hour period.
- No more than 1-1.5 liters of fluid should be removed at any one time. (Correct answer)
- It is important to fully drain the pleural space each time the catheter is accessed.
Correct answer: No more than 1-1.5 liters of fluid should be removed at any one time.
Draw the fluid off gradually, removing no more than one to 1.5 liters at a time, in order to prevent vasovagal symptoms (tachycardia, hypotension, and fainting). If the pleural space is more than 1.5 liters, fully draining it could cause discomfort, vasovagal reactions, and coughing. It is preferable to train a caregiver on how to access the catheter safely in a palliative context. Drainage should never last longer than eight hours since continued catheter access can cause infection or emboli.
Question 7: Due to advanced ovarian cancer, Vangie has an incomplete bowel blockage. She is throwing up feces and complaining of severe abdominal pain. Only non-pharmacologic therapies are desired by her and her family. Which intervention is most likely to be successful?
- Foley catheter
- Nasogastric tube (Correct answer)
- Bowel rest
- High fiber diet
Correct answer: Nasogastric tube
The most suitable technique at this stage of obstruction is the insertion of a nasogastric tube for decompression venting and emptying of stomach contents. Although intestinal rest is essential, it won't clear the stomach's contents and, ideally, prevent vomiting. The obstruction cannot be resolved with a Foley catheter, and introducing food while the obstruction is still present will make matters worse.
Question 8: After receiving a PEG tube, 69-year-old Eric, who has end-stage esophageal cancer, recently left the hospital and went back home. Margaret, his wife, who will be taking care of him, says she trained to give him his tube feedings while he was in the hospital. How should Margaret be evaluated to see how well she can complete this task?
- Ask her to describe the instructions she was given.
- Ask her husband if she is performing it correctly.
- Ask her to tell you how she performs it.
- Ask her to show you how she performs it. (Correct answer)
Correct answer: Ask her to show you how she performs it.
The best way to see that she is competent is to have her demonstrate the ability for you. The following actions should, at the very least, be taken after teaching patients or caregivers how to perform a particular skill or task: First, Ask for a statement of understanding; Second, Watch a follow-up demonstration, if applicable; and Third, Record the answer. These are crucial components in guaranteeing patient safety and adult education.
Question 9: A person suffering from persistent obstructive pulmonary patient with COPD is given a portable nebulizer. Upon administration of albuterol, the patient reports elevated mental alertness, a fast heartbeat, and the nurse is aware that the drug has caused sleeplessness. encouraged the:
- System nervousAutonomic
- Sympathetic nervous systems (Correct answer)
- Parasympathetic nervous system
- Central nervous system
Correct answer: Sympathetic nervous systems
Mental disorders are caused by sympathetic nervous system stimulation, consciousness, elevated heart rate, and elevated cardiac reduced digestion, bronch odilation, contractility, and localized vasodilation.
Question 10: The most prevalent lung disease at its end stage observed in hospice environments is:
- Lung cancer (Correct answer)
- Cystic fibrosis
- Tuberculosis
- Chronic obstructive pulmonary disease (COPD)
Correct answer: Lung cancer
COPD is the most frequent respiratory condition observed in hospice settings, after lung cancer.
Question 11: A 57-year-old individual with advanced liver Hepatic encephalopathy is being treated for the condition. 30 milliliters of lactulose BID. The patient is conscious and focused and mentions having multiple episodes of watery diarrhea, one of which led to this morning's incontinence. The caregiver ought to?
- Inform the patient that the diarrhea is a side effect of the lactulose
- Advise the patient to hold the next dose of lactulose (Correct answer)
- Advise the patient to take 2 mg of loperamide orally after each loose stool
- Encourage the patient to replace fluids and electrolyte with sports drinks
Correct answer: Advise the patient to hold the next dose of lactulose
Diarrhea is a severe adverse effect of lactulose that frequently if left untreated, leads to noncompliance. Since the question stem is alert, it is safe to give the patient instructions to reserve the lactulose dose for later. The medicine's dosage will need to be modified in order for the patient to receive the medicine with no unpleasant side effects.
Free Certified Hospice and Palliative Nurse Questions and Answers
Which patient is most likely to not receive adequate care for their pain symptoms?