CERTIFIED HOSPICE PALLIATIVE NURSE CHPN EXAM LATEST
VERSION WITH ALL QUESTIONS FROM ACTUAL EXAM 100%
CORRECT ANSWERS, AND RATIONALE
cultural consideration to pain - CORRECT ANSWERS-native American & Alaskan natives:
unwilling to show pain or request meds. endured rather than tx
Asian & Pacific islanders: dont vocalize pain & may use non traditional methods like acupuncture
Black & African American: openly express pain but believe it should be endured. Avoid meds fear of
addiction or stigmatism
Hispanic culture: value ability to endure pain. expression by a male is a sign of weakness. pain is a gorm
of godly punishment or trial
gender consideration pain - CORRECT ANSWERS-women seek help sooner than men.
experience more visceral pain
NSAIDs - CORRECT ANSWERS-anti-inflammatory & antipyretuc
1st defense for inflammatory conditions
A/E: GI bleed, ulcers, dec. renal, impaired platelets, short term memory in elderly
cant use beyond 6-12 months
*allergy to sulfa may be contraindicated *
myoclonus - CORRECT ANSWERS-the sudden, involuntary jerking of a muscle or group of
muscles.
occurs opiods in high doses w/ renal failure, seizures can occur
others include brain surgery, intrathecal placement, AIDs dementia, hypoxia.
nocturnal is common
Adjuvent - CORRECT ANSWERS-additional treatment after primary treatment.
generally w/ opiod
antidepressants, anticonvulsant, corticosteroids
,Ketamine- pain crisis - CORRECT ANSWERS-0.1 mg/kg IV if no response follow up in 5 minutes
& repeat PRN
decrease opiod by 50%
1 mg/min for 70 kg person
subcutaneous is possible 0.3-0.5 mg/kg
consider benzo w/ to prevent hallucinations/bad dreams.
if ^ secretions use glycopyrrolate, scopalamine or atropine
outcome indicators for palliative care - CORRECT ANSWERS-Bring pain not managed within pt
comfort level in first 48 hrs
pain control should be maintained
not controlled needs active intervention
A/E should be anticipated & prevented or tx.
EOL meds - CORRECT ANSWERS-controlling pain with meds does not shorten or expand life
span. cant hasten or cause death when used responsibly
methadone: common, safe, and inexpensive
addiction/respiratory depression is only a concern when the pt is 1st introduced to opiod
Morphine - CORRECT ANSWERS-No ceiling dose (often used for pt w/ CA)
Different forms: IV, IM, IR, SR, Long-acting, liquid, suppositories
s/e: sedation, respiratory depression, itching, nausea, chronic spasms, twitching, constipation
after a few days pts overcome itching, nausea, Resp depression, sedation
AIDS infection - CORRECT ANSWERS-Bacterial, Viral, Fungal, Parasitic
AIDS dementia - CORRECT ANSWERS-causes Encephalopathy, 15% effected
ALS (amyotrophic lateral sclerosis) 1st symptom - CORRECT ANSWERS-swallowing difficulty
followed by distal weakness
, Cerebral Metastases - CORRECT ANSWERS-Brain mets account for 40% of all Cancer patients.
Cerebral Metastases symptoms - CORRECT ANSWERS-HA initial complaint, N/V, confusion,
lethargy
Leukemia 2 types - CORRECT ANSWERS-chronic and acute
Leukemia Clinical Manifestations - CORRECT ANSWERS-Infection, fever, enlarged liver, spleen,
kidneys, bleeding/bruising not explained, & hemorrhage
pale, petechia, purpura
liver failure symptoms - CORRECT ANSWERS-fatigue, jaundice, ascites
Dark urine, gray stool, bruising
symptoms of bleeding internally - CORRECT ANSWERS-sudden fever > 101°, dyspnea,
abdominal paik, dehydration
Lymphoma types - CORRECT ANSWERS-Hodgkins and Non-Hodgkins
Hodgkin's disease - CORRECT ANSWERS-painless lymph node swelling, generally in upper
body, general fatigue, weight loss, fever, nifht sweats, back pain
Non-Hodgkin's Lymphoma - CORRECT ANSWERS-same symptoms except itching & night
sweats
Parkinson's disease - CORRECT ANSWERS-Slow progression of motor skills, resting tremors,
slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - CORRECT ANSWERS-pill rolling movements in bands, loss of
facial expression, difficulty initiating movement, gait changes
VERSION WITH ALL QUESTIONS FROM ACTUAL EXAM 100%
CORRECT ANSWERS, AND RATIONALE
cultural consideration to pain - CORRECT ANSWERS-native American & Alaskan natives:
unwilling to show pain or request meds. endured rather than tx
Asian & Pacific islanders: dont vocalize pain & may use non traditional methods like acupuncture
Black & African American: openly express pain but believe it should be endured. Avoid meds fear of
addiction or stigmatism
Hispanic culture: value ability to endure pain. expression by a male is a sign of weakness. pain is a gorm
of godly punishment or trial
gender consideration pain - CORRECT ANSWERS-women seek help sooner than men.
experience more visceral pain
NSAIDs - CORRECT ANSWERS-anti-inflammatory & antipyretuc
1st defense for inflammatory conditions
A/E: GI bleed, ulcers, dec. renal, impaired platelets, short term memory in elderly
cant use beyond 6-12 months
*allergy to sulfa may be contraindicated *
myoclonus - CORRECT ANSWERS-the sudden, involuntary jerking of a muscle or group of
muscles.
occurs opiods in high doses w/ renal failure, seizures can occur
others include brain surgery, intrathecal placement, AIDs dementia, hypoxia.
nocturnal is common
Adjuvent - CORRECT ANSWERS-additional treatment after primary treatment.
generally w/ opiod
antidepressants, anticonvulsant, corticosteroids
,Ketamine- pain crisis - CORRECT ANSWERS-0.1 mg/kg IV if no response follow up in 5 minutes
& repeat PRN
decrease opiod by 50%
1 mg/min for 70 kg person
subcutaneous is possible 0.3-0.5 mg/kg
consider benzo w/ to prevent hallucinations/bad dreams.
if ^ secretions use glycopyrrolate, scopalamine or atropine
outcome indicators for palliative care - CORRECT ANSWERS-Bring pain not managed within pt
comfort level in first 48 hrs
pain control should be maintained
not controlled needs active intervention
A/E should be anticipated & prevented or tx.
EOL meds - CORRECT ANSWERS-controlling pain with meds does not shorten or expand life
span. cant hasten or cause death when used responsibly
methadone: common, safe, and inexpensive
addiction/respiratory depression is only a concern when the pt is 1st introduced to opiod
Morphine - CORRECT ANSWERS-No ceiling dose (often used for pt w/ CA)
Different forms: IV, IM, IR, SR, Long-acting, liquid, suppositories
s/e: sedation, respiratory depression, itching, nausea, chronic spasms, twitching, constipation
after a few days pts overcome itching, nausea, Resp depression, sedation
AIDS infection - CORRECT ANSWERS-Bacterial, Viral, Fungal, Parasitic
AIDS dementia - CORRECT ANSWERS-causes Encephalopathy, 15% effected
ALS (amyotrophic lateral sclerosis) 1st symptom - CORRECT ANSWERS-swallowing difficulty
followed by distal weakness
, Cerebral Metastases - CORRECT ANSWERS-Brain mets account for 40% of all Cancer patients.
Cerebral Metastases symptoms - CORRECT ANSWERS-HA initial complaint, N/V, confusion,
lethargy
Leukemia 2 types - CORRECT ANSWERS-chronic and acute
Leukemia Clinical Manifestations - CORRECT ANSWERS-Infection, fever, enlarged liver, spleen,
kidneys, bleeding/bruising not explained, & hemorrhage
pale, petechia, purpura
liver failure symptoms - CORRECT ANSWERS-fatigue, jaundice, ascites
Dark urine, gray stool, bruising
symptoms of bleeding internally - CORRECT ANSWERS-sudden fever > 101°, dyspnea,
abdominal paik, dehydration
Lymphoma types - CORRECT ANSWERS-Hodgkins and Non-Hodgkins
Hodgkin's disease - CORRECT ANSWERS-painless lymph node swelling, generally in upper
body, general fatigue, weight loss, fever, nifht sweats, back pain
Non-Hodgkin's Lymphoma - CORRECT ANSWERS-same symptoms except itching & night
sweats
Parkinson's disease - CORRECT ANSWERS-Slow progression of motor skills, resting tremors,
slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - CORRECT ANSWERS-pill rolling movements in bands, loss of
facial expression, difficulty initiating movement, gait changes
