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CHPN Practice Exam

2025 Edition

Take this free CHPN practice test to get a sample of the types of questions on the actual Hospice and Palliative Nurse certification exam.

The CHPN exam is a 3 hour exam covering 150 multiple choice questions. The CHPN exam focuses on five domain practice areas: Life-limiting Conditions in Adult Patients, Pain Management, Symptom Management, Patient and Family Care and Practical Issues.

You can also try the Complete 750 Question CHPN Practice Exam Kit with fully explained answers, testing tips and more.

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Patient Care: Assessment and Planning

1.	Alzheimer disease is associated with what characteristics?
		a. Pre-clinical and symptomatic phases
Alzheimer disease is one type of dementia, with a known pre-clinical phase during which pathophysiologic changes begin to occur, followed by a symptomatic phase where cognitive and functional decline becomes noticeable. Lewy body deposits in the brain are associated with Lewy body dementia only. The degree of dementia progression often depends on underlying factors, although there is some evidence suggesting that early-onset Alzheimer patients progress more rapidly. Irreversible organ failure is not a hallmark characteristic; instead, pain, constipation, and behavioral changes are the most common symptoms. Incorrect answer. Please choose another answer.
		b. Lewy body deposits
Alzheimer disease is one type of dementia, with a known pre-clinical phase during which pathophysiologic changes begin to occur, followed by a symptomatic phase where cognitive and functional decline becomes noticeable. Lewy body deposits in the brain are associated with Lewy body dementia only. The degree of dementia progression often depends on underlying factors, although there is some evidence suggesting that early-onset Alzheimer patients progress more rapidly. Irreversible organ failure is not a hallmark characteristic; instead, pain, constipation, and behavioral changes are the most common symptoms. Incorrect answer. Please choose another answer.
		c. A more accelerated decline in older patients
Alzheimer disease is one type of dementia, with a known pre-clinical phase during which pathophysiologic changes begin to occur, followed by a symptomatic phase where cognitive and functional decline becomes noticeable. Lewy body deposits in the brain are associated with Lewy body dementia only. The degree of dementia progression often depends on underlying factors, although there is some evidence suggesting that early-onset Alzheimer patients progress more rapidly. Irreversible organ failure is not a hallmark characteristic; instead, pain, constipation, and behavioral changes are the most common symptoms. Incorrect answer. Please choose another answer.
		d. Slow, irreversible organ failure
Alzheimer disease is one type of dementia, with a known pre-clinical phase during which pathophysiologic changes begin to occur, followed by a symptomatic phase where cognitive and functional decline becomes noticeable. Lewy body deposits in the brain are associated with Lewy body dementia only. The degree of dementia progression often depends on underlying factors, although there is some evidence suggesting that early-onset Alzheimer patients progress more rapidly. Irreversible organ failure is not a hallmark characteristic; instead, pain, constipation, and behavioral changes are the most common symptoms. Incorrect answer. Please choose another answer.

Patient Care: Assessment and Planning

2.	You are the nurse on-call and receive a call from a continuous care nurse who states that her patient has started to have "rattling" secretions and the patient's wife is very concerned. You know from report that this patient is actively dying. What would be the most appropriate response?
		a. Reposition patient on his side
Noisy, congested respirations (known as "terminal secretions") are very common during the dying process, and are also sometimes referred to as a “death rattle”. Typically, they do not cause discomfort for the patient, but can be very distressing to family members. Repositioning the patient by turning him on his side can be helpful to decrease the noise associated with this situation. Anticholinergics can also be administered, but typically, once the secretions start, anticholinergic effectiveness is limited. Incorrect answer. Please choose another answer.
		b. Administer furosemide
Noisy, congested respirations (known as "terminal secretions") are very common during the dying process, and are also sometimes referred to as a “death rattle”. Typically, they do not cause discomfort for the patient, but can be very distressing to family members. Repositioning the patient by turning him on his side can be helpful to decrease the noise associated with this situation. Anticholinergics can also be administered, but typically, once the secretions start, anticholinergic effectiveness is limited. Incorrect answer. Please choose another answer.
		c. Suction the patient
Noisy, congested respirations (known as "terminal secretions") are very common during the dying process, and are also sometimes referred to as a “death rattle”. Typically, they do not cause discomfort for the patient, but can be very distressing to family members. Repositioning the patient by turning him on his side can be helpful to decrease the noise associated with this situation. Anticholinergics can also be administered, but typically, once the secretions start, anticholinergic effectiveness is limited. Incorrect answer. Please choose another answer.
		d. Order oxygen for the patient
Noisy, congested respirations (known as "terminal secretions") are very common during the dying process, and are also sometimes referred to as a “death rattle”. Typically, they do not cause discomfort for the patient, but can be very distressing to family members. Repositioning the patient by turning him on his side can be helpful to decrease the noise associated with this situation. Anticholinergics can also be administered, but typically, once the secretions start, anticholinergic effectiveness is limited. Incorrect answer. Please choose another answer.

Patient Care: Assessment and Planning

3.	Which characteristics are most closely associated with end-stage renal disease?
		a. 20% or less of normal renal function exists; consequence of coronary artery disease
End-stage renal disease (ESRD) is diagnosed when <10% of normal renal function exists, and is often a consequence of diabetes or hypertension. Alcohol misuse or comorbidities such as coronary artery disease, peripheral vascular disease, or malnutrition may be present, but are not causative factors. Treatment includes dialysis, but also kidney transplantation. African Americans, not Hispanic populations, are disproportionately affected by ESRD. Oliguria, not polyuria, is a symptom of ESRD. Incorrect answer. Please choose another answer.
		b. Consequence of alcohol misuse; only treatment is dialysis
End-stage renal disease (ESRD) is diagnosed when <10% of normal renal function exists, and is often a consequence of diabetes or hypertension. Alcohol misuse or comorbidities such as coronary artery disease, peripheral vascular disease, or malnutrition may be present, but are not causative factors. Treatment includes dialysis, but also kidney transplantation. African Americans, not Hispanic populations, are disproportionately affected by ESRD. Oliguria, not polyuria, is a symptom of ESRD. Incorrect answer. Please choose another answer.
		c. 10% or less of normal renal function exists; consequence of diabetes
End-stage renal disease (ESRD) is diagnosed when <10% of normal renal function exists, and is often a consequence of diabetes or hypertension. Alcohol misuse or comorbidities such as coronary artery disease, peripheral vascular disease, or malnutrition may be present, but are not causative factors. Treatment includes dialysis, but also kidney transplantation. African Americans, not Hispanic populations, are disproportionately affected by ESRD. Oliguria, not polyuria, is a symptom of ESRD. Incorrect answer. Please choose another answer.
		d. Affects Hispanic population disproportionately; symptoms include polyuria
End-stage renal disease (ESRD) is diagnosed when <10% of normal renal function exists, and is often a consequence of diabetes or hypertension. Alcohol misuse or comorbidities such as coronary artery disease, peripheral vascular disease, or malnutrition may be present, but are not causative factors. Treatment includes dialysis, but also kidney transplantation. African Americans, not Hispanic populations, are disproportionately affected by ESRD. Oliguria, not polyuria, is a symptom of ESRD. Incorrect answer. Please choose another answer.

Patient Care: Assessment and Planning

4.	Mary is a 73-year-old patient with a 50-year history of smoking and a diagnosis of emphysema. She is very thin with a barrel chest, has intermittent dyspnea both at rest and with exertion, and supraclavicular retractions on exertion. What non-pharmacologic intervention would likely improve dyspnea in this patient?
		a. Lowering the head of the bed
Patients with emphysema may find some relief from dyspnea by leaning forward while sitting, and placing arms over a table (“tripod position”), due to the lengthened tension-state of the diaphragm in this position. Lowering the head of the bed would likely worsen dyspnea; pursed mouth-breathing, rather than deep nose-breathing, would be of greater benefit to lessening dyspnea; although guided imagery may improve mood, evidence does not demonstrate that it affects dyspnea directly. Incorrect answer. Please choose another answer.
		b. Positioning in the tripod position
Patients with emphysema may find some relief from dyspnea by leaning forward while sitting, and placing arms over a table (“tripod position”), due to the lengthened tension-state of the diaphragm in this position. Lowering the head of the bed would likely worsen dyspnea; pursed mouth-breathing, rather than deep nose-breathing, would be of greater benefit to lessening dyspnea; although guided imagery may improve mood, evidence does not demonstrate that it affects dyspnea directly. Incorrect answer. Please choose another answer.
		c. Slow, deep meditative breathing through the nose
Patients with emphysema may find some relief from dyspnea by leaning forward while sitting, and placing arms over a table (“tripod position”), due to the lengthened tension-state of the diaphragm in this position. Lowering the head of the bed would likely worsen dyspnea; pursed mouth-breathing, rather than deep nose-breathing, would be of greater benefit to lessening dyspnea; although guided imagery may improve mood, evidence does not demonstrate that it affects dyspnea directly. Incorrect answer. Please choose another answer.
		d. Guided imagery
Patients with emphysema may find some relief from dyspnea by leaning forward while sitting, and placing arms over a table (“tripod position”), due to the lengthened tension-state of the diaphragm in this position. Lowering the head of the bed would likely worsen dyspnea; pursed mouth-breathing, rather than deep nose-breathing, would be of greater benefit to lessening dyspnea; although guided imagery may improve mood, evidence does not demonstrate that it affects dyspnea directly. Incorrect answer. Please choose another answer.

Patient Care: Assessment and Planning

5.	John is a new hospice patient with heart failure. John reports a six-pound weight gain since his discharge from the hospital 3 days ago. The nurse notes that John has dependent peripheral edema 2 +, and he reports feeling nauseated and with poor appetite. Based on these findings, what is the pathophysiology of John's heart disease?
		a. Systolic dysfunction, with poor cardiac output
John's symptoms are due to right sided (diastolic) heart failure, when the ventricle does not fill adequately, leading to a generalized edema of the extremities and the hepatic system. Symptoms of right sided failure include nausea, anorexia, peripheral edema, ascites, weakness, and weight gain. Poor cardiac output, decreased ejection fraction, organ perfusion failure are indicative of left-sided heart failure. Incorrect answer. Please choose another answer.
		b. Diastolic dysfunction, with poor ventricle filling
John's symptoms are due to right sided (diastolic) heart failure, when the ventricle does not fill adequately, leading to a generalized edema of the extremities and the hepatic system. Symptoms of right sided failure include nausea, anorexia, peripheral edema, ascites, weakness, and weight gain. Poor cardiac output, decreased ejection fraction, organ perfusion failure are indicative of left-sided heart failure. Incorrect answer. Please choose another answer.
		c. Decreased ejection fraction
John's symptoms are due to right sided (diastolic) heart failure, when the ventricle does not fill adequately, leading to a generalized edema of the extremities and the hepatic system. Symptoms of right sided failure include nausea, anorexia, peripheral edema, ascites, weakness, and weight gain. Poor cardiac output, decreased ejection fraction, organ perfusion failure are indicative of left-sided heart failure. Incorrect answer. Please choose another answer.
		d. Generalized organ perfusion failure
John's symptoms are due to right sided (diastolic) heart failure, when the ventricle does not fill adequately, leading to a generalized edema of the extremities and the hepatic system. Symptoms of right sided failure include nausea, anorexia, peripheral edema, ascites, weakness, and weight gain. Poor cardiac output, decreased ejection fraction, organ perfusion failure are indicative of left-sided heart failure. Incorrect answer. Please choose another answer.

CHPN Practice Exam

Patient Care: Assessment and Planning

Patient Care: Assessment and Planning

Patient Care: Assessment and Planning

Patient Care: Assessment and Planning

Patient Care: Assessment and Planning

Patient Care: Assessment and Planning

Patient Care: Pain Management

Patient Care: Pain Management

Patient Care: Pain Management

Patient Care: Pain Management

Patient Care: Pain Management

Patient Care: Pain Management

Patient Care: Symptom Management

Patient Care: Symptom Management

Patient Care: Symptom Management

Patient Care: Symptom Management

Patient Care: Assessment and Planning

6.	A nurse is meeting a patient for the first time. When introducing himself, the nurse notes a series of symptoms that are concerning for acute stroke. Which symptoms are associated with acute stroke?
		a. Hyperventilation and bowel incontinence
Acute stroke is associated with aphasia (which may include difficulty with both understanding and with verbalizing speech), ataxia, numbness or paralysis of limbs or face, vision disturbances, and headaches, which may illicit vomiting. The other symptoms are not indicative of acute stroke symptoms. Incorrect answer. Please choose another answer.
		b. Difficulty understanding speech and blurry vision
Acute stroke is associated with aphasia (which may include difficulty with both understanding and with verbalizing speech), ataxia, numbness or paralysis of limbs or face, vision disturbances, and headaches, which may illicit vomiting. The other symptoms are not indicative of acute stroke symptoms. Incorrect answer. Please choose another answer.
		c. Vomiting and dyspnea
Acute stroke is associated with aphasia (which may include difficulty with both understanding and with verbalizing speech), ataxia, numbness or paralysis of limbs or face, vision disturbances, and headaches, which may illicit vomiting. The other symptoms are not indicative of acute stroke symptoms. Incorrect answer. Please choose another answer.
		d. Generalized weakness and dysphagia
Acute stroke is associated with aphasia (which may include difficulty with both understanding and with verbalizing speech), ataxia, numbness or paralysis of limbs or face, vision disturbances, and headaches, which may illicit vomiting. The other symptoms are not indicative of acute stroke symptoms. Incorrect answer. Please choose another answer.

Patient Care: Pain Management

7.	Which of the following most accurately describes "breakthrough" pain?
		a. Associated with pathological fractures
Breakthrough pain is intermittent episodes of pain that occur in patients with chronic pain. This type of pain can be related to some type of activity, of unknown origin, or can occur as analgesic failure at the end of a pain medication's period of effectiveness. Opioid regimens for pain management in the hospice and palliative care setting should include a long-acting agent, once dosing need is established, and a short-acting agent to cover episodes of breakthrough pain. Incorrect answer. Please choose another answer.
		b. Refers to a new psychological or spiritual insight
Breakthrough pain is intermittent episodes of pain that occur in patients with chronic pain. This type of pain can be related to some type of activity, of unknown origin, or can occur as analgesic failure at the end of a pain medication's period of effectiveness. Opioid regimens for pain management in the hospice and palliative care setting should include a long-acting agent, once dosing need is established, and a short-acting agent to cover episodes of breakthrough pain. Incorrect answer. Please choose another answer.
		c. Can occur as end-of-dose failure
Breakthrough pain is intermittent episodes of pain that occur in patients with chronic pain. This type of pain can be related to some type of activity, of unknown origin, or can occur as analgesic failure at the end of a pain medication's period of effectiveness. Opioid regimens for pain management in the hospice and palliative care setting should include a long-acting agent, once dosing need is established, and a short-acting agent to cover episodes of breakthrough pain. Incorrect answer. Please choose another answer.
		d. An aspect of opioid pseudo-addiction
Breakthrough pain is intermittent episodes of pain that occur in patients with chronic pain. This type of pain can be related to some type of activity, of unknown origin, or can occur as analgesic failure at the end of a pain medication's period of effectiveness. Opioid regimens for pain management in the hospice and palliative care setting should include a long-acting agent, once dosing need is established, and a short-acting agent to cover episodes of breakthrough pain. Incorrect answer. Please choose another answer.

Patient Care: Pain Management

8.	Madge is an 88 year-old with end stage colon cancer, who is transitioning. She has been minimally responsive for the past six hours, but opens her eyes in response to her name. She is restless at times with furrowing of her brow. She is still swallowing her secretions, and sucks on the oral sponge when mouth care is provided. Prior to her change in status, she was receiving Oxycontin 40 mg po tablets q12 hr ATC with liquid oxycodone 8-12 mg po q2hrs prn for breakthrough pain. In light of Madge's change in level of consciousness, what changes should be made to her pain management regimen?
		a. Convert to IV infusion
Since the oral route is always preferred if possible, Madge should be converted to liquid dosing of her current long-acting pain medication q 4hrs ATC (convert from Oxycontin® to liquid oxycodone), while maintaining the same dosing as currently ordered for breakthrough pain. Since most liquid forms are quite concentrated, even patients who are minimally responsive can tolerate such small volumes in the buccal space and typically maintain excellent pain control. Incorrect answer. Please choose another answer.
		b. Convert to subcutaneous infusion
Since the oral route is always preferred if possible, Madge should be converted to liquid dosing of her current long-acting pain medication q 4hrs ATC (convert from Oxycontin® to liquid oxycodone), while maintaining the same dosing as currently ordered for breakthrough pain. Since most liquid forms are quite concentrated, even patients who are minimally responsive can tolerate such small volumes in the buccal space and typically maintain excellent pain control. Incorrect answer. Please choose another answer.
		c. Convert to liquid dosing orally
Since the oral route is always preferred if possible, Madge should be converted to liquid dosing of her current long-acting pain medication q 4hrs ATC (convert from Oxycontin® to liquid oxycodone), while maintaining the same dosing as currently ordered for breakthrough pain. Since most liquid forms are quite concentrated, even patients who are minimally responsive can tolerate such small volumes in the buccal space and typically maintain excellent pain control. Incorrect answer. Please choose another answer.
		d. Convert to fentanyl patch
Since the oral route is always preferred if possible, Madge should be converted to liquid dosing of her current long-acting pain medication q 4hrs ATC (convert from Oxycontin® to liquid oxycodone), while maintaining the same dosing as currently ordered for breakthrough pain. Since most liquid forms are quite concentrated, even patients who are minimally responsive can tolerate such small volumes in the buccal space and typically maintain excellent pain control. Incorrect answer. Please choose another answer.

Patient Care: Pain Management

9.	Which patient is at most risk for under-treatment of pain symptoms?
		a. 86-year old female with COPD, living in an assisted living facility
A frequent misconception is that younger patients with few co-morbidities are at greatest risk for under-treatment for pain, but in fact the elderly, minorities, and women are most at risk for under-treatment. Of the four case scenarios, the 86-year old has two of the three risk factors. Incorrect answer. Please choose another answer.
		b. 74-year old male with congestive heart failure, living with his wife
A frequent misconception is that younger patients with few co-morbidities are at greatest risk for under-treatment for pain, but in fact the elderly, minorities, and women are most at risk for under-treatment. Of the four case scenarios, the 86-year old has two of the three risk factors. Incorrect answer. Please choose another answer.
		c. 51-year old male, recently diagnosed with ALS; a former weight lifter
A frequent misconception is that younger patients with few co-morbidities are at greatest risk for under-treatment for pain, but in fact the elderly, minorities, and women are most at risk for under-treatment. Of the four case scenarios, the 86-year old has two of the three risk factors. Incorrect answer. Please choose another answer.
		d. 42-year old female with early-onset dementia, living with her sister.
A frequent misconception is that younger patients with few co-morbidities are at greatest risk for under-treatment for pain, but in fact the elderly, minorities, and women are most at risk for under-treatment. Of the four case scenarios, the 86-year old has two of the three risk factors. Incorrect answer. Please choose another answer.

Patient Care: Pain Management

10.	Margaret is an 87-year old with breast cancer that has metastasized to bone and brain. She lives alone, and is checked in on by a neighbor every other day. During a home visit, Margaret complains of dull, constant pain in her back and breastbone. The nurse notes that the oxycodone tablets that he had counted out for her for the last two days are still in the pill box; Margaret cannot explain why she did not take them as prescribed. This is the second occasion when the nurse has found tablets not taken. What is an appropriate pain management strategy for Margaret?
		a. Margaret should be admitted to an inpatient hospice for pain control.
Transdermal fentanyl, also known as a fentanyl patch, is a good choice for individuals with pain who cannot swallow or do not remember to take their medication, and would need to be titrated to effect for this patient. It is a particularly good choice for Margaret because she may be forgetful due to her brain metastasis, which would not improve by providing liquid morphine instead of tablets. As she does not live with a caregiver, depending on the neighbor to assure adequate pain management is not an effective plan. As Margaret is not in pain crisis, symptom control efforts should be initiated and the effect evaluated before referral to an inpatient hospice setting. Incorrect answer. Please choose another answer.
		b. The oxycodone should be replaced with equianalgesic transdermal fentanyl.
Transdermal fentanyl, also known as a fentanyl patch, is a good choice for individuals with pain who cannot swallow or do not remember to take their medication, and would need to be titrated to effect for this patient. It is a particularly good choice for Margaret because she may be forgetful due to her brain metastasis, which would not improve by providing liquid morphine instead of tablets. As she does not live with a caregiver, depending on the neighbor to assure adequate pain management is not an effective plan. As Margaret is not in pain crisis, symptom control efforts should be initiated and the effect evaluated before referral to an inpatient hospice setting. Incorrect answer. Please choose another answer.
		c. The oxycodone should be replaced with an equianalgesic liquid morphine.
Transdermal fentanyl, also known as a fentanyl patch, is a good choice for individuals with pain who cannot swallow or do not remember to take their medication, and would need to be titrated to effect for this patient. It is a particularly good choice for Margaret because she may be forgetful due to her brain metastasis, which would not improve by providing liquid morphine instead of tablets. As she does not live with a caregiver, depending on the neighbor to assure adequate pain management is not an effective plan. As Margaret is not in pain crisis, symptom control efforts should be initiated and the effect evaluated before referral to an inpatient hospice setting. Incorrect answer. Please choose another answer.
		d. A neighbor should be tasked to give Margaret her medications.
Transdermal fentanyl, also known as a fentanyl patch, is a good choice for individuals with pain who cannot swallow or do not remember to take their medication, and would need to be titrated to effect for this patient. It is a particularly good choice for Margaret because she may be forgetful due to her brain metastasis, which would not improve by providing liquid morphine instead of tablets. As she does not live with a caregiver, depending on the neighbor to assure adequate pain management is not an effective plan. As Margaret is not in pain crisis, symptom control efforts should be initiated and the effect evaluated before referral to an inpatient hospice setting. Incorrect answer. Please choose another answer.

Patient Care: Pain Management

11.	What should be prescribed concurrently with any opioid regimen?
		a. Ondansetron
As constipation is a significant side effects of opioid therapy, any patient on an opioid should also be prescribed a prophylactic bowel regimen to prevent or manage constipation. Senna is a simulant laxative that chemically stimulates the bowel to increase motility. Ondansetron HCl is a 5-HT3 receptor antagonist, used to prevent nausea and vomiting; diphenhydramine is an antihistamine used to treat opioid- induced pruritus; pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain. Incorrect answer. Please choose another answer.
		b. Diphenhydramine
As constipation is a significant side effects of opioid therapy, any patient on an opioid should also be prescribed a prophylactic bowel regimen to prevent or manage constipation. Senna is a simulant laxative that chemically stimulates the bowel to increase motility. Ondansetron HCl is a 5-HT3 receptor antagonist, used to prevent nausea and vomiting; diphenhydramine is an antihistamine used to treat opioid- induced pruritus; pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain. Incorrect answer. Please choose another answer.
		c. Senna
As constipation is a significant side effects of opioid therapy, any patient on an opioid should also be prescribed a prophylactic bowel regimen to prevent or manage constipation. Senna is a simulant laxative that chemically stimulates the bowel to increase motility. Ondansetron HCl is a 5-HT3 receptor antagonist, used to prevent nausea and vomiting; diphenhydramine is an antihistamine used to treat opioid- induced pruritus; pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain. Incorrect answer. Please choose another answer.
		d. Pamidronate
As constipation is a significant side effects of opioid therapy, any patient on an opioid should also be prescribed a prophylactic bowel regimen to prevent or manage constipation. Senna is a simulant laxative that chemically stimulates the bowel to increase motility. Ondansetron HCl is a 5-HT3 receptor antagonist, used to prevent nausea and vomiting; diphenhydramine is an antihistamine used to treat opioid- induced pruritus; pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain. Incorrect answer. Please choose another answer.

Patient Care: Pain Management

12.	Jordan is taking continuous-release morphine every 12 hours for pain control, and has a short-acting prn opioid for break through pain. He is experiencing end-of-dose failure at 9-10 hours. What would be the most appropriate intervention to manage Jordan's pain?
		a. The dose should be decreased every 12 hours, but the short-acting prn dose should be increased by 25%.
Jordan is experiencing end-of-dose failure, which indicates that in the last hours of the dosing cycle, the blood levels of the drug are decreasing before uptake of the next scheduled dose. This is different than breakthrough pain, characterized by episode of pain despite control of continuous baseline pain. By shortening the round-the-close drug interval, Jordan will experience more stable drug blood levels. Increasing the prn dosing would only result in a short-acting bolus just prior to the next dosing cycle and could cause sedation and other side effects. A switch to another opioid is not necessary as this is typically done due to an undesirable side effect. A corticosteroid would not provide the desired pain management result in the last hours of the dosing cycle. Incorrect answer. Please choose another answer.
		b. An adjuvant therapy such as a corticosteroid should be added.
Jordan is experiencing end-of-dose failure, which indicates that in the last hours of the dosing cycle, the blood levels of the drug are decreasing before uptake of the next scheduled dose. This is different than breakthrough pain, characterized by episode of pain despite control of continuous baseline pain. By shortening the round-the-close drug interval, Jordan will experience more stable drug blood levels. Increasing the prn dosing would only result in a short-acting bolus just prior to the next dosing cycle and could cause sedation and other side effects. A switch to another opioid is not necessary as this is typically done due to an undesirable side effect. A corticosteroid would not provide the desired pain management result in the last hours of the dosing cycle. Incorrect answer. Please choose another answer.
		c. Jordan should be switched to an equianalgesic alternative opioid
Jordan is experiencing end-of-dose failure, which indicates that in the last hours of the dosing cycle, the blood levels of the drug are decreasing before uptake of the next scheduled dose. This is different than breakthrough pain, characterized by episode of pain despite control of continuous baseline pain. By shortening the round-the-close drug interval, Jordan will experience more stable drug blood levels. Increasing the prn dosing would only result in a short-acting bolus just prior to the next dosing cycle and could cause sedation and other side effects. A switch to another opioid is not necessary as this is typically done due to an undesirable side effect. A corticosteroid would not provide the desired pain management result in the last hours of the dosing cycle. Incorrect answer. Please choose another answer.
		d. 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
Jordan is experiencing end-of-dose failure, which indicates that in the last hours of the dosing cycle, the blood levels of the drug are decreasing before uptake of the next scheduled dose. This is different than breakthrough pain, characterized by episode of pain despite control of continuous baseline pain. By shortening the round-the-close drug interval, Jordan will experience more stable drug blood levels. Increasing the prn dosing would only result in a short-acting bolus just prior to the next dosing cycle and could cause sedation and other side effects. A switch to another opioid is not necessary as this is typically done due to an undesirable side effect. A corticosteroid would not provide the desired pain management result in the last hours of the dosing cycle. Incorrect answer. Please choose another answer.

Patient Care: Symptom Management

13.	Of the following, which may indicate a poor prognosis for the hospice patient with a diagnosis of end-stage cardiac disease?
		a. Infection
Unexplained syncope, as well as previous cardiac arrest with resuscitation, and an embolic stroke originating from the cardiac system are all indicators of poor prognosis in this patient population. Incorrect answer. Please choose another answer.
		b. Edema
Unexplained syncope, as well as previous cardiac arrest with resuscitation, and an embolic stroke originating from the cardiac system are all indicators of poor prognosis in this patient population. Incorrect answer. Please choose another answer.
		c. Bleeding
Unexplained syncope, as well as previous cardiac arrest with resuscitation, and an embolic stroke originating from the cardiac system are all indicators of poor prognosis in this patient population. Incorrect answer. Please choose another answer.
		d. Unexplained syncope
Unexplained syncope, as well as previous cardiac arrest with resuscitation, and an embolic stroke originating from the cardiac system are all indicators of poor prognosis in this patient population. Incorrect answer. Please choose another answer.

Patient Care: Symptom Management

14.	When a hospice patient is facing increasing weakness, with increased fatigue and decreased mobility, which of the following is an important aspect of supporting the patient's care needs?
		a. Prioritizing energy use
Prioritizing energy use is an important aspect of supporting the hospice patient who is experiencing progressive weakness and fatigue. Helping the patient to identify which activities are most important to physical, emotional and spiritual needs empowers the patient to spend limited energy on those aspects that matter most to them. Incorrect answer. Please choose another answer.
		b. Honoring the wishes of family members
Prioritizing energy use is an important aspect of supporting the hospice patient who is experiencing progressive weakness and fatigue. Helping the patient to identify which activities are most important to physical, emotional and spiritual needs empowers the patient to spend limited energy on those aspects that matter most to them. Incorrect answer. Please choose another answer.
		c. Remaining as mobile as possible
Prioritizing energy use is an important aspect of supporting the hospice patient who is experiencing progressive weakness and fatigue. Helping the patient to identify which activities are most important to physical, emotional and spiritual needs empowers the patient to spend limited energy on those aspects that matter most to them. Incorrect answer. Please choose another answer.
		d. Seeing as many visitors as possible
Prioritizing energy use is an important aspect of supporting the hospice patient who is experiencing progressive weakness and fatigue. Helping the patient to identify which activities are most important to physical, emotional and spiritual needs empowers the patient to spend limited energy on those aspects that matter most to them. Incorrect answer. Please choose another answer.

Patient Care: Symptom Management

15.	Terri has an indwelling pleural catheter in place for intermittent drainage of her pleural effusion. The nurse is present to provide teaching on the use of the catheter at home. Which point is important for the nurse to stress to Terri to avoid vasovagal symptoms?
		a. The drainage should occur slowly and continuously over an 8-hour period.
To avoid vasovagal symptoms (tachycardia, hypotension, fainting), it is important to draw the fluid off slowly with no more than 1-1.5 liters removed at any one time. Fully draining the pleural space (if more than 1.5 liters is present) could result in pain, vasovagal responses, and cough. In the palliative setting, it is ideal to have a caregiver instructed on how to properly access the catheter. Drainage should never occur over an 8-hour period, as prolonged catheter access can result in infection or embolus. Incorrect answer. Please choose another answer.
		b. No more than 1-1.5 liters of fluid should be removed at any one time.
To avoid vasovagal symptoms (tachycardia, hypotension, fainting), it is important to draw the fluid off slowly with no more than 1-1.5 liters removed at any one time. Fully draining the pleural space (if more than 1.5 liters is present) could result in pain, vasovagal responses, and cough. In the palliative setting, it is ideal to have a caregiver instructed on how to properly access the catheter. Drainage should never occur over an 8-hour period, as prolonged catheter access can result in infection or embolus. Incorrect answer. Please choose another answer.
		c. It is important to fully drain the pleural space each time the catheter is accessed.
To avoid vasovagal symptoms (tachycardia, hypotension, fainting), it is important to draw the fluid off slowly with no more than 1-1.5 liters removed at any one time. Fully draining the pleural space (if more than 1.5 liters is present) could result in pain, vasovagal responses, and cough. In the palliative setting, it is ideal to have a caregiver instructed on how to properly access the catheter. Drainage should never occur over an 8-hour period, as prolonged catheter access can result in infection or embolus. Incorrect answer. Please choose another answer.
		d. The catheter can only be accessed by a nurse.
To avoid vasovagal symptoms (tachycardia, hypotension, fainting), it is important to draw the fluid off slowly with no more than 1-1.5 liters removed at any one time. Fully draining the pleural space (if more than 1.5 liters is present) could result in pain, vasovagal responses, and cough. In the palliative setting, it is ideal to have a caregiver instructed on how to properly access the catheter. Drainage should never occur over an 8-hour period, as prolonged catheter access can result in infection or embolus. Incorrect answer. Please choose another answer.

Patient Care: Symptom Management

16.	Daryl has an incomplete bowel obstruction secondary to metastatic ovarian cancer. She is experiencing significant abdominal pain and is vomiting fecal matter. She and her family want non-pharmacologic interventions only. Which intervention is likely to be the most effective?