Free Hospice and Palliative Nurse Guide Questions and Answers — Questions and Answers
Question 1: A patient's sole experience with opioid use isnot grow accustomed to it.
- Nausea
- Vomiting
- Pruritus
- Constipation (Correct answer)
Correct answer: Constipation
While nausea, vomiting, and pruritus are common side effects of opioid use, the body typically develops tolerance to these symptoms over time. However, opioid-induced constipation (OIC) is a persistent side effect that does not improve with continued use because opioids act on mu-opioid receptors in the gastrointestinal tract, slowing motility, and tolerance to this effect does not develop.
Question 2: The implementation of advance instructions occurs when a patient:
- Completes a physician (or provider) order for life- sustaining treatment (POLST)
- Designates a power of attorney
- Becomes terminally ill
- Cannot express his or her own wishes (Correct answer)
Correct answer: Cannot express his or her own wishes
Advance directives are legal documents that become effective when a patient loses the capacity to make or communicate their own healthcare decisions. They are put into action precisely at the point when the patient's voice can no longer be heard, ensuring their previously stated wishes are honored regarding medical treatment and end-of-life care.
Question 3: When will her recently deceased grandmother return, wonders a 4-year-old child. Her mother clarifies as follows: She is unable to return. The young person nods, but subsequently poses the same query. As an illustration, consider this as:
- A sign of advanced developmental level
- Regression to earlier stage of development
- Denial regarding the permanence of the death
- Congruence with developmental level (Correct answer)
Correct answer: Congruence with developmental level
A 4-year-old child's understanding of death is typically concrete and often lacks the concept of permanence. They may view death as temporary or reversible, or believe the deceased can still return. Repeatedly asking if a deceased person will return, even after being told no, is a normal cognitive and emotional response for this developmental stage.
Question 4: Which of these services is not included in the Medicare Benefit for Hospice?
- Pet therapy (Correct answer)
- Personal care
- Light housekeeping
- Medication management
Correct answer: Pet therapy
The Medicare Hospice Benefit covers a comprehensive range of services, including personal care, light housekeeping (as it relates to patient care), medication management, nursing care, and social work. While pet therapy can be beneficial for emotional support, it is generally considered an ancillary or complementary service and is not explicitly covered as a core service under the standard Medicare Hospice Benefit.
Question 5: A 1.5-inch foam overlay covers the mattress of a bedridden patient. When the nurse puts her palm beneath the overlay, she discovers that it has crushed to a depth of 0.75 inches. This suggests:
- Excess wear
- Moisture retention
- Bottoming out (Correct answer)
- Adequate support
Correct answer: Bottoming out
'Bottoming out' occurs when a patient's weight compresses a support surface, such as a mattress overlay, to the point where their body rests directly on the underlying, firmer surface of the bed. The nurse's palm sinking to 0.75 inches beneath a 1.5-inch overlay indicates that the overlay is no longer providing adequate pressure redistribution, increasing the risk of pressure injury.
Question 6: Which medication is classified as a very fast-acting, short-acting benzodiazepine and is used for terminal sedation?
- Midazolam (Correct answer)
- Lorazepam
- Pentobarbital
- Propofol
Correct answer: Midazolam
Midazolam is a short-acting benzodiazepine known for its rapid onset and short duration of action, making it highly suitable for acute sedation and terminal sedation. It effectively reduces anxiety, induces sleep, and can help manage refractory symptoms like agitation or dyspnea at the end of life, providing comfort quickly.
Question 7: Nearly all people with amyotrophic lateral sclerosis (ALS) in its last stages:
- Exhibit slight slurring of speech.
- Exhibit signs of dementia.
- Require mechanical ventilation to breathe. (Correct answer)
- Have weight gain.
Correct answer: Require mechanical ventilation to breathe.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that primarily affects motor neurons, leading to muscle weakness and atrophy throughout the body. In its late stages, the respiratory muscles become severely weakened, making it impossible for patients to breathe independently. Consequently, most individuals with late-stage ALS require mechanical ventilation to sustain life.
Question 8: The best course of action for bringing down a fever that is higher than 38.8° C (102° F) is:
- Cold bath
- Aspirin
- Acetaminophen or ibuprofen (Correct answer)
Correct answer: Acetaminophen or ibuprofen
Acetaminophen or ibuprofen are antipyretics, meaning they work to reduce fever by acting on the brain's temperature-regulating center. They are considered the safest and most effective first-line treatments for fever in most cases. Cold baths can induce shivering, which paradoxically increases body temperature, and aspirin is generally avoided in children and adolescents due to the risk of Reye's syndrome.
Question 9: Myelosuppression has occurred in a patient receiving chemotherapy in palliative care urged to stay away from everything listed here, with the exception of:
- High-protein diet (Correct answer)
- Strenuous activities
- Alcohol
- Shaving the legs, underarms, or face
Correct answer: High-protein diet
Myelosuppression, a common side effect of chemotherapy, reduces blood cell production, increasing risks like infection and bleeding. A high-protein diet is beneficial for these patients as it supports immune function, helps maintain muscle mass, and aids in tissue repair, all crucial for recovery and overall health. Other options like strenuous activities, alcohol, and shaving are generally discouraged due to increased risks in a myelosuppressed state.
Question 10: Fentanyl patches are used by an ovarian cancer patient to manage their pain. She laments that she is having trouble urinating abruptly and that she is only dribbling little amounts. The patient has bilateral flank pain, but there is no dilation of the bladder. She's not feverish. There is a mild hyperkalemia in her electrolyte count. The most plausible reason is:
- Bladder infection
- Opioid-induced deficiency of detrusor muscle contraction
- Upper urinary tract obstruction (Correct answer)
- Bladder neck obstruction
Correct answer: Upper urinary tract obstruction
The patient's symptoms—abrupt difficulty urinating, dribbling, bilateral flank pain, and mild hyperkalemia, without bladder dilation or fever—strongly indicate an upper urinary tract obstruction. Bilateral flank pain points to kidney involvement, and hyperkalemia can result from impaired kidney function due to obstruction. While opioids can cause urinary retention, it typically presents with bladder distention, which is absent here.
Free Hospice and Palliative Nurse Guide Questions and Answers
A patient's sole experience with opioid use isnot grow accustomed to it.