NACE Hospice, Palliative Care, and End-of-Life Nursing 2

Question 1

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

Accepted Answer

A stimulant laxative such as senna with a stool softener

Answer

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

Question 2

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

Accepted Answer

Low-dose morphine

Answer

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

Question 3

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

Accepted Answer

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

Answer

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

Question 4

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

Accepted Answer

12–24 mg

Answer

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

Question 5

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

Accepted Answer

Increasing sedation

Answer

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

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test