Hospice, Palliative Care, and End-of-Life Nursing Flashcards

A hospice patient starts scheduled oral morphine for cancer pain. Which order should the nurse expect at the same time?

Answer: A stimulant laxative such as senna with a stool softener

Opioids slow gut motility and tolerance to constipation never develops, so a stimulant laxative is started prophylactically.

Which medication is first-line for relieving dyspnea in a terminally ill patient?

Answer: Low-dose morphine

Low-dose opioids reduce the sensation of breathlessness and are first-line for end-of-life dyspnea.

Family members are distressed by loud, gurgling respirations in an actively dying, unresponsive patient. Which intervention is most appropriate?

Answer: Repositioning side-lying and giving an anticholinergic such as glycopyrrolate as ordered

Terminal secretions respond best to positioning and anticholinergics that dry secretions; deep suctioning is distressing and rarely effective.

A patient receives 120 mg of oral morphine per 24 hours. Which breakthrough dose range is generally appropriate?

Answer: 12–24 mg

Breakthrough doses are typically 10–20% of the total 24-hour opioid dose.

When titrating opioids for a palliative patient, which assessment finding usually appears before opioid-induced respiratory depression?

Answer: Increasing sedation

Sedation precedes respiratory depression, so monitoring sedation level is the key safety assessment.

A dying patient becomes acutely restless, pulling at lines and hallucinating, after reversible causes have been ruled out. Which medication is commonly used first?

Answer: Haloperidol

Haloperidol is the first-line antipsychotic for terminal delirium once reversible causes are addressed.

Why should meperidine be avoided for pain control in older hospice patients?

Answer: Its metabolite normeperidine accumulates and can cause seizures

Normeperidine accumulates, especially with reduced renal function, causing neurotoxicity and seizures.