HOSPICE AND PALLIATIVE REGISTERED
NURSE CERTIFICATION EXAM QUESTIONS
AND CORRECT ANSWERS
Which assessment findings would most strongly suggest an issue with
morphine? - ANSWER>>myoclonus is a symptom of the toxic effects of
morphine metabolites
Which cancer is least likely to metastasize to the bone? - ANSWER>>Colorectal;
it mainly metastasizes to the liver, lung, and peritoneum.
What is the drug of choice to relieve a patient's feeling of "air hunger" in end
stage pulmonary disease? - ANSWER>>morphine; opioids provide palliative
support for symptoms of breathlessness or suffocation.
What is not an appropriate intervention for a bowel obstruction -
ANSWER>>Metoclopramide
The classic signs of superior vena cava syndrome (SVCS) - ANSWER>>facial
edema, dyspnea, edematous arms w/bluish color=this is oncologic emergency
requiring immediate attention.
anticipatory grief - ANSWER>>the proces of psychological, social, and somatic
reactions to a perceived future loss.
signs and symptoms of imminent death - ANSWER>>dysphagia
stage II skin breakdown - ANSWER>>skin is blistered, cracked or abraded
The state of having suffered a loss - ANSWER>>bereavement
Disseminated Intravascular Coagulation (DIC) - ANSWER>>focal ischemia,
widespread thrombosis or bleeding, superficial gangrene, jaundice,
acrocyanosis, altered sensation, ulceration of gastrointestinal system, decreased
urinary output, and dyspnea.
,prognosis of days to weeks, intervention for dysphagia - ANSWER>>teach family
the importance of oral hygiene to prevent complications such as mouth
soreness and infections.
safety is a priority w/persons w/dementia - ANSWER>>supervision, minimal
stimulation, and discouraging sleep during daytime hours maximize night safety.
xerostomia - ANSWER>>dry mouth, and can be a side effect of medications and
a long term effect of radiation.
spiritual care of the hospice patient and family - ANSWER>>identifies and strives
to relieve the spiritual suffering of the patient and family
Grief - ANSWER>>the feelings related to the perception of the loss and is a
normal reaction to loss.
mentoring - ANSWER>>a relationship between an experienced person and a less
experienced person
Justice - ANSWER>>to consider rules and actions that result in fair and equitable
use of available resources.
medicare hospice benefit periods - ANSWER>>90-, 90-, and unlimited 60-day
periods
crossing of professional boundaries - ANSWER>>providing a personal cell phone
number to the family
syncopal episodes and falls - ANSWER>>consider discontinuing antihypertensive
medications if blood pressure is consistently low
When revoking the medicare hospice benefit - ANSWER>>The patient will lose
the remaining days of the current period if they revoke the medicare hospice
benefit
, The dose-limiting side effect of morphine - ANSWER>>Myoclonus=myoclonus is
the chronic spasm of a muscle; if moclonus is present, accepted practice is to
rotate to another opioid.
first priority when pt. unable to make own decisions and being cared for by
family - ANSWER>>knowing how the family makes decisions and who the
decision makers are is priority.
therapy for stage II wounds - ANSWER>>relieve pressure and apply
protective/occlusive dressings.
starting oral dose for methadone - ANSWER>>2.5-5 mg every 8 hours (half dose
for elderly or severe renal or liver disease)
side effect of methadone - ANSWER>>prolong QT interval
equianalgesic conversion process -step one - ANSWER>>step one- add up the
total amount of the current drug given in 24 hours
remember to add in both the scheduled and breakthrough or rescue doses
Calculate separately if more than one drug
epuianalgesic conversion process -step two - ANSWER>>step two- Divide
current 24 hour total by the equianalgesic value for the current drug and route
of administration.
Most commonly used opioid analgesics
Morphine-Parental 10mg/enteral 30mg
codeine-parental 130mg/enteral 200mg (not recommended)
fentanyl-parental 50-100 mcg/ enteral TRIF (transmucosal immediate release
fentanyl)
hydrocodone- parental n/a enteral 30 mg.
hydromorphone- parental 1.5mg/enteral 7.5mg.
levorphanol-parental 2 mg acute, 1mg. chronic/enteral 4mg. acute 1 mg. chronic
methadone-parental unknown/ enteral unknown
oxycodone-parental n/a enteral 20mg.
NURSE CERTIFICATION EXAM QUESTIONS
AND CORRECT ANSWERS
Which assessment findings would most strongly suggest an issue with
morphine? - ANSWER>>myoclonus is a symptom of the toxic effects of
morphine metabolites
Which cancer is least likely to metastasize to the bone? - ANSWER>>Colorectal;
it mainly metastasizes to the liver, lung, and peritoneum.
What is the drug of choice to relieve a patient's feeling of "air hunger" in end
stage pulmonary disease? - ANSWER>>morphine; opioids provide palliative
support for symptoms of breathlessness or suffocation.
What is not an appropriate intervention for a bowel obstruction -
ANSWER>>Metoclopramide
The classic signs of superior vena cava syndrome (SVCS) - ANSWER>>facial
edema, dyspnea, edematous arms w/bluish color=this is oncologic emergency
requiring immediate attention.
anticipatory grief - ANSWER>>the proces of psychological, social, and somatic
reactions to a perceived future loss.
signs and symptoms of imminent death - ANSWER>>dysphagia
stage II skin breakdown - ANSWER>>skin is blistered, cracked or abraded
The state of having suffered a loss - ANSWER>>bereavement
Disseminated Intravascular Coagulation (DIC) - ANSWER>>focal ischemia,
widespread thrombosis or bleeding, superficial gangrene, jaundice,
acrocyanosis, altered sensation, ulceration of gastrointestinal system, decreased
urinary output, and dyspnea.
,prognosis of days to weeks, intervention for dysphagia - ANSWER>>teach family
the importance of oral hygiene to prevent complications such as mouth
soreness and infections.
safety is a priority w/persons w/dementia - ANSWER>>supervision, minimal
stimulation, and discouraging sleep during daytime hours maximize night safety.
xerostomia - ANSWER>>dry mouth, and can be a side effect of medications and
a long term effect of radiation.
spiritual care of the hospice patient and family - ANSWER>>identifies and strives
to relieve the spiritual suffering of the patient and family
Grief - ANSWER>>the feelings related to the perception of the loss and is a
normal reaction to loss.
mentoring - ANSWER>>a relationship between an experienced person and a less
experienced person
Justice - ANSWER>>to consider rules and actions that result in fair and equitable
use of available resources.
medicare hospice benefit periods - ANSWER>>90-, 90-, and unlimited 60-day
periods
crossing of professional boundaries - ANSWER>>providing a personal cell phone
number to the family
syncopal episodes and falls - ANSWER>>consider discontinuing antihypertensive
medications if blood pressure is consistently low
When revoking the medicare hospice benefit - ANSWER>>The patient will lose
the remaining days of the current period if they revoke the medicare hospice
benefit
, The dose-limiting side effect of morphine - ANSWER>>Myoclonus=myoclonus is
the chronic spasm of a muscle; if moclonus is present, accepted practice is to
rotate to another opioid.
first priority when pt. unable to make own decisions and being cared for by
family - ANSWER>>knowing how the family makes decisions and who the
decision makers are is priority.
therapy for stage II wounds - ANSWER>>relieve pressure and apply
protective/occlusive dressings.
starting oral dose for methadone - ANSWER>>2.5-5 mg every 8 hours (half dose
for elderly or severe renal or liver disease)
side effect of methadone - ANSWER>>prolong QT interval
equianalgesic conversion process -step one - ANSWER>>step one- add up the
total amount of the current drug given in 24 hours
remember to add in both the scheduled and breakthrough or rescue doses
Calculate separately if more than one drug
epuianalgesic conversion process -step two - ANSWER>>step two- Divide
current 24 hour total by the equianalgesic value for the current drug and route
of administration.
Most commonly used opioid analgesics
Morphine-Parental 10mg/enteral 30mg
codeine-parental 130mg/enteral 200mg (not recommended)
fentanyl-parental 50-100 mcg/ enteral TRIF (transmucosal immediate release
fentanyl)
hydrocodone- parental n/a enteral 30 mg.
hydromorphone- parental 1.5mg/enteral 7.5mg.
levorphanol-parental 2 mg acute, 1mg. chronic/enteral 4mg. acute 1 mg. chronic
methadone-parental unknown/ enteral unknown
oxycodone-parental n/a enteral 20mg.
