Free Hospice and Palliative Nurse Basic Questions and Answers — Questions and Answers
Question 1: Which of the following is the FIRST action to take if a hospice has made the decision to investigate the effects of nebulized morphine?
- Obtain physician approval.
- Review previous studies. (Correct answer)
- Write an informed consent document.
- Submit a research grant proposal.
Correct answer: Review previous studies.
Before initiating any new research, especially involving medication or patient care, the first crucial step is to conduct a thorough literature review. Reviewing previous studies helps to understand existing knowledge, identify gaps, avoid duplicating efforts, and ensure the proposed research is ethical and well-informed. This foundational step guides the entire research process.
Question 2: When attending to a patient's spiritual needs, which of the following is imperative?
- Obtaining permission to contact the patient's clergy.
- Sharing ones own spiritual beliefs with the patient.
- Discerning when physical symptoms are indicative of spiritual concerns. (Correct answer)
- Being available to pray with the patient.
Correct answer: Discerning when physical symptoms are indicative of spiritual concerns.
When addressing a patient's spiritual needs, it is imperative for the nurse to recognize that spiritual distress can manifest as physical symptoms or exacerbate existing ones. By discerning when physical complaints might have underlying spiritual roots, the nurse can provide holistic care that addresses the patient's comprehensive well-being, rather than solely focusing on physical aspects.
Question 3: Six doses of sustained-release morphine were needed for a patient of morphine with quick release within a day for breakthrough pain. If the doctor worries whether raising the baseline maintained The nurses' BEST course of action upon releasing morphine would be to talk:
- Ease of therapy delivery. (Correct answer)
- Elevating the pain threshold.
- Cost-effectiveness.
- Erasing pain memory.
Correct answer: Ease of therapy delivery.
If a patient requires frequent breakthrough pain medication despite being on sustained-release morphine, the doctor might consider increasing the baseline sustained-release dose. The nurse's best course of action upon discussing this would be to emphasize the 'ease of therapy delivery,' as a higher sustained-release dose could reduce the frequency of breakthrough doses, simplifying the regimen for both patient and caregivers.
Question 4: His wife is taking care of their 39-year-old father who is near death. His two room is off-limits to small children. How can an interdisciplinary team start out?"
- Have a volunteer stay with the children for a few hours.
- Discuss with the parents their reasons for the childrens exclusion. (Correct answer)
- Respect the parents wishes and refer the children to a grief group.
- Arrange for spiritual and social work counseling for the family.
Correct answer: Discuss with the parents their reasons for the childrens exclusion.
In a sensitive situation like a parent nearing death, the interdisciplinary team's initial approach should be to understand the family's perspective. Discussing the parents' reasons for excluding small children allows the team to assess their concerns, offer appropriate support, and gently explore options for involving the children in a way that respects the parents' wishes while also addressing the children's needs.
Question 5: The most common side effect of chemotherapy that causes concern to the patient is:
- Cardiotoxicity- loss of cardiac muscle tone, congestive heart failure
- Gastrointestinal symptoms- nausea, vomiting, diarrhea (Correct answer)
- Neurptoxicity- peripheral neuropathies, constipation
- Nephrotoxicity- blood in urine, renal failure
Correct answer: Gastrointestinal symptoms- nausea, vomiting, diarrhea
Chemotherapy often targets rapidly dividing cells, including those in the gastrointestinal tract, leading to common and distressing side effects. Nausea, vomiting, and diarrhea are frequently reported by patients undergoing chemotherapy and are often a major source of discomfort and concern, significantly impacting their quality of life.
Question 6: A patient has chosen to enroll in a hospice program in instead of stopping dialysis. Of the symptoms listed below, which one should the nurse be ready to effectively in this patient?
- Hypotension, ascites, and confusion
- Hiccoughs, pain, and arrhythmias.
- Nausea, dry mouth, and pruitus. (Correct answer)
- Constipation, fever, and seizures.
Correct answer: Nausea, dry mouth, and pruitus.
When a patient with end-stage renal disease chooses hospice over dialysis, the cessation of dialysis will lead to a buildup of toxins and fluid. This commonly causes symptoms such as nausea (from uremia), dry mouth (due to fluid shifts and uremia), and pruritus (itching, also due to uremia). The nurse should be prepared to manage these specific symptoms effectively.
Question 7: Pain due to stimulants which does not normally provoke pain is:
- Neuralgia
- Allodyina (Correct answer)
- Paresthesia
- Hyperalgesic
Correct answer: Allodyina
Allodynia is a type of neuropathic pain characterized by pain due to a stimulus that does not normally provoke pain. For example, a light touch or brushing against the skin might cause severe pain. This condition is distinct from hyperalgesia (increased pain sensitivity) or paresthesia (abnormal sensations).
Question 8: When converting a cylinder system from an oxygen concertrator, The patient's relatives ought to be informed that:
- A lower air flow should be used with a cylinder system.
- The guaged cylinders should be stabilized in an upright position. (Correct answer)
- Extra cylinders should be stored in a closet.
- Humidification is necessary with a cylinder system.
Correct answer: The guaged cylinders should be stabilized in an upright position.
Oxygen cylinders contain pressurized gas and must be handled with care for safety. It is crucial to inform patients and their families that cylinders, especially those with gauges, should always be stabilized in an upright position. This prevents them from falling, which could cause injury or damage to the valve, leading to a dangerous gas leak.
Question 9: The nurse should provide instructions before starting opioids round-the-clock. The patient and their family that the sedative's typical duration:
- Several hours
- A few days (Correct answer)
- A few weeks
- Throughout the course of treatment
Correct answer: A few days
When initiating round-the-clock opioids, patients and families should be informed about potential side effects, including sedation. Typically, the sedative effects of opioids are most pronounced during the first few days of treatment as the body adjusts. After this initial period, tolerance to the sedative effects usually develops, allowing patients to remain more alert while still achieving pain relief.
Question 10: A patient who was previously taking 300 mg of extended-release phenytoin. The oral capsule used before bed is being switched to phenytoin, Which of the following is required right now?
- Changing the dosing interval of phenytoin (Correct answer)
- Adding a corticosteroid
- Decreasing the dose of phenytoin
- Increasing the dose of phenytoin
Correct answer: Changing the dosing interval of phenytoin
Phenytoin is an anticonvulsant with a narrow therapeutic index and complex pharmacokinetics. Switching from an extended-release formulation, typically taken once daily, to a standard oral capsule formulation requires careful adjustment of the dosing interval. Standard phenytoin capsules usually need to be administered more frequently (e.g., two or three times a day) to maintain stable therapeutic levels, unlike the extended-release version.
Question 11: Due to the significant immune system suppression caused by the AIDS virus patients have a higher risk of contracting opportunistic infections due to the most typical of which is:
- Tuberculosis
- Pseudomonas
- Disseminated CMV (cytomegalovirus)
- PCP (pneumocystis carini pneumonia) (Correct answer)
Correct answer: PCP (pneumocystis carini pneumonia)
Patients with AIDS experience severe immunosuppression, making them highly susceptible to opportunistic infections. Pneumocystis carinii pneumonia (PCP), now often referred to as Pneumocystis jirovecii pneumonia, was historically and remains one of the most common and life-threatening opportunistic infections in individuals with AIDS, especially before the widespread use of effective antiretroviral therapy.
Free Hospice and Palliative Nurse Basic Questions and Answers
Which of the following is the FIRST action to take if a hospice has made the decision to investigate the effects of nebulized morphine?