Chpn: Quiz About Nurses

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Chpn: Quiz About Nurses - Quiz

The Certified Hospice and Palliative Nurse (CHPN®) examination was designed for experienced hospice and palliative registered nurses. To be eligible for the HPCC CHPN® Examination, an applicant must hold a current, unrestricted registered nurse license in the United States. Take this quiz to know your CHPN Aptitude.


Questions and Answers
  • 1. 

    Grief can BEST be described as changes in feeling and behaviors that occur in response to

    • A.

      Perceived loss

    • B.

      Unexpressed anger

    • C.

      A terminal diagnosis

    • D.

      Physical and emotional stress

    Correct Answer
    A. Perceived loss
    Explanation
    Grief can be described as the changes in feelings and behaviors that occur in response to a perceived loss. When someone experiences a loss, such as the death of a loved one or the end of a relationship, they may go through a grieving process. This process involves a range of emotions, including sadness, anger, and confusion. It can also lead to changes in behavior, such as withdrawal from social activities or difficulty concentrating. Overall, grief is a natural response to loss and can vary in intensity and duration for each individual.

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  • 2. 

    Six weeks after admission to hspice, an elderly wife is no longer able to care for her husband. They have no relatives. Neighbors are helpful, but also elderly. The couple wants to remain at home. Which of the following should the nurse recommend?

    • A.

      A social work referral

    • B.

      Nursing home placement

    • C.

      Daily home health aid visits

    • D.

      Volunteer visits 3 times a day

    Correct Answer
    A. A social work referral
    Explanation
    Given the information provided, the nurse should recommend a social work referral. The elderly wife is no longer able to care for her husband and they have no relatives to assist them. The neighbors are elderly as well, which may limit their ability to provide ongoing support. A social work referral would allow for a professional assessment of the couple's needs and the development of a care plan that could include resources and assistance to help them remain at home. This would be the most appropriate recommendation to ensure the couple's well-being and safety.

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  • 3. 

    Early assessment and diagnosis of spinal cord compression is important because

    • A.

      Advanced pain management techniques can be initiated before the pain worsens.

    • B.

      Is it ually the cause of death that could be delayed by timely treatment.

    • C.

      Permanent neurological dysfunction, includes paralysis, will result if untreated.

    • D.

      Physical therpay can be instituted to help prevent loss of strength in the lower extremities.

    Correct Answer
    C. Permanent neurological dysfunction, includes paralysis, will result if untreated.
    Explanation
    Early assessment and diagnosis of spinal cord compression is important because if left untreated, it can lead to permanent neurological dysfunction, including paralysis. Timely treatment can help prevent such complications and preserve the patient's neurological function.

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  • 4. 

    The spouse of a patient who is terminally ill calls to report that her husband has become very confused. He is going through his closet and packing a suitcase for a trip. The nurse should explain to the wife that  

    • A.

      She should administer a sedative to help him relax.

    • B.

      She should convience him that his trip has been cancelled.

    • C.

      Similiar behavior have been noted in patients approaching death.

    • D.

      Her husband has become agitated due to his opioid therapy.

    Correct Answer
    C. Similiar behavior have been noted in patients approaching death.
    Explanation
    Similar behavior has been noted in patients approaching death. This explanation suggests that the confusion and packing behavior exhibited by the terminally ill patient is a common occurrence among patients who are nearing the end of their lives. It implies that this behavior is a result of the patient's deteriorating condition and is not something that can be easily controlled or eliminated.

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  • 5. 

    A patients physcian has ordered a placebo by injection on a routine basis. The nurse should

    • A.

      Decline to adminster a placebo.

    • B.

      Teach the family to administer the placebo.

    • C.

      Assess the patients response to the placebo.

    • D.

      Recognize that psychological pain is often relieved by placebos.

    Correct Answer
    A. Decline to adminster a placebo.
    Explanation
    The nurse should decline to administer a placebo because it goes against ethical principles. A placebo is a substance or treatment that has no therapeutic effect, and administering it without the patient's knowledge or consent is considered deceptive and dishonest. It is important for healthcare professionals to prioritize the well-being and trust of their patients, and administering a placebo without their knowledge or consent would violate that trust.

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  • 6. 

    A patient with AIDS is referred to the hospice program and is taking a combination antietroviral agents. Which of the following is MOST important to consider when proceeding with evaluation for the hospice program?

    • A.

      Antiretrovial agents are an appropriate palliative therapy until the patient dies.

    • B.

      A patient is admitted to hospice only when antireviral agents have been discontinued.

    • C.

      Antirevirals agents are not covered under the Medicare Hospice or Medicaid benefits.

    • D.

      A discussion of treatment goals with the attending physicain and the patient/family is recommended prior to admission.

    Correct Answer
    D. A discussion of treatment goals with the attending physicain and the patient/family is recommended prior to admission.
    Explanation
    The most important consideration when evaluating a patient with AIDS for the hospice program is to have a discussion about treatment goals with the attending physician and the patient/family prior to admission. This is important because it allows for a comprehensive understanding of the patient's wishes, preferences, and expectations regarding their care. By having this discussion, the hospice program can ensure that they provide appropriate palliative therapy, including antiretroviral agents if necessary, while also respecting the patient's goals and desires for their end-of-life care.

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  • 7. 

    A patient receiving sustained-release morphine has required 6 doses of immediate release morphine in 24 hours for breakthrough pain. If the physician questions the need to increase the baseline sustained-relase morphine, the nurses BEST response would be to discuss

    • A.

      Cost-effectiveness.

    • B.

      Erasing pain memory.

    • C.

      Ease of therapy delivery.

    • D.

      Elevating the pain threshold.

    Correct Answer
    C. Ease of therapy delivery.
    Explanation
    The nurse's best response would be to discuss the ease of therapy delivery. This is because the patient has required multiple doses of immediate release morphine for breakthrough pain while receiving sustained-release morphine. By discussing the ease of therapy delivery, the nurse can explore alternative options that may provide better pain management and minimize the need for additional doses.

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  • 8. 

    A patient has decided to stop dialysis and enter a hospice program. Which of the following symptoms should the nurse be prepared to manage in this patient?

    • A.

      Hiccoughs, pain, and arrhythmias.

    • B.

      Nausea, dry mouth, and pruitus.

    • C.

      Constipation, fever, and seizures.

    • D.

      Hypotension, ascites, and confusion

    Correct Answer
    B. Nausea, dry mouth, and pruitus.
    Explanation
    When a patient decides to stop dialysis and enter a hospice program, they are typically in the end stages of a terminal illness. Nausea, dry mouth, and pruritus (itching) are common symptoms that can occur in these patients due to multiple factors such as medication side effects, metabolic imbalances, and the progression of the underlying disease. Managing these symptoms is important to ensure the patient's comfort and quality of life during this stage.

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  • 9. 

    When initiating around the clock opioids, the nurse should instruct the patient and family that the sedative effect usually last

    • A.

      A few days

    • B.

      A few weeks

    • C.

      Several hours

    • D.

      Throughout the course of treatment

    Correct Answer
    A. A few days
    Explanation
    When initiating around the clock opioids, the nurse should instruct the patient and family that the sedative effect usually lasts a few days. This means that the sedative effect of the opioids will likely continue for a few days after starting the treatment. It is important for the patient and family to be aware of this duration so that they can be prepared for any potential side effects or changes in the patient's behavior during this time.

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  • 10. 

    According to the NHPCO standards for hospice program of care, every hospice team member should address work-related grief and loss issues by

    • A.

      Attending support groups.

    • B.

      Recieving counseling services.

    • C.

      Having access to emotional support.

    • D.

      Participating in debriefing sessions.

    Correct Answer
    C. Having access to emotional support.
    Explanation
    According to the NHPCO standards for hospice program of care, every hospice team member should have access to emotional support. This means that they should have resources available to them to help them cope with work-related grief and loss issues. This could include having access to counseling services, support groups, or debriefing sessions. Having emotional support is essential for hospice team members to process their emotions and prevent burnout in their challenging work environment.

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  • 11. 

    A 51 year old home care patient has end stage alcoholic cirrhosis. He has a history of physical and emotional abuse towards his wife and daughters. He is receving 360 mg of sustained release morphine every 12 hours with 100 mg of immediate-release morphine every hr prn. He consistently rates his pain as an 8/10. After adjusting the pain medications, which of the following would be the most appropriate action?

    • A.

      Obtain an order for an anxiety medication.

    • B.

      Discuss placement in a long-term care facility.

    • C.

      Consider a plan to address unresolved relationship issues.

    • D.

      Arrage for a volunteer to provide respite care for the wife.

    Correct Answer
    C. Consider a plan to address unresolved relationship issues.
    Explanation
    The most appropriate action would be to consider a plan to address unresolved relationship issues. The patient's consistent rating of pain as 8/10 despite receiving high doses of pain medication suggests that there may be underlying psychological factors contributing to his perception of pain. Given his history of physical and emotional abuse towards his wife and daughters, it is important to address these unresolved relationship issues as they may be impacting his overall well-being and pain perception. This could involve counseling or therapy to address the dynamics within the family and work towards resolving any conflicts or issues.

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  • 12. 

    A nurse notices a group of unilateral vesicular eruptions with a dermatomal distribution on a patient's back. Which of the following should be suspected?

    • A.

      Hives

    • B.

      Herpes zoster

    • C.

      Contact dermatitis

    • D.

      Herpes simplex

    Correct Answer
    B. Herpes zoster
    Explanation
    A nurse should suspect herpes zoster when observing unilateral vesicular eruptions with a dermatomal distribution on a patient's back. Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. The characteristic distribution pattern along a specific nerve pathway distinguishes herpes zoster from other skin conditions such as hives, contact dermatitis, or herpes simplex.

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  • 13. 

    A patient with end stage congestive heart failure has been referred to hospice by his family practice physician. Which of the following is the MOST important information needed to evaluate medical appropriateness for the hospice program?

    • A.

      Oxygen use, medication history, mental status

    • B.

      Dobutamine therapy, history of cor pulmonale, chest x ray

    • C.

      Ejection fraction, recent hospitalizations, performance status

    • D.

      Nutritional status, desire for hospice program, Karnofsky score

    Correct Answer
    C. Ejection fraction, recent hospitalizations, performance status
    Explanation
    The ejection fraction, recent hospitalizations, and performance status are the most important factors to evaluate the medical appropriateness for the hospice program in a patient with end-stage congestive heart failure. The ejection fraction indicates the pumping ability of the heart, recent hospitalizations reflect the severity of the condition and the need for intensive medical care, and the performance status assesses the patient's overall functional ability and quality of life. These factors help determine the prognosis and the level of medical support and care required for the patient in the hospice program.

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  • 14. 

    A steriod can be prescribed for an anorexic patient who complains of weakness and lack of energy in order to

    • A.

      Increase strength.

    • B.

      Treat underlying infection.

    • C.

      Address electrolyte imbalance

    • D.

      Induce a feeling of well-being.

    Correct Answer
    A. Increase strength.
    Explanation
    Steroids are known to have anabolic effects, which means they can increase muscle strength and mass. An anorexic patient who complains of weakness and lack of energy may benefit from a steroid prescription to help improve their strength and overall physical condition. Steroids can help stimulate protein synthesis and promote muscle growth, leading to increased strength and energy levels.

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  • 15. 

    A hospice patient in a nursing home has refused intravenous and tube feedings in the past and has indicated her wishes in an advance directive, The patients condition has deteriorated and intake is minimal. The nursing home staff is concerned the patient will starve to death and request nasogastric tueb feedings. Which of the following is the BEST action for the nurse?

    • A.

      Request an ethics consult.

    • B.

      Share the staffs concern with the patient and family.

    • C.

      Consider a time-limited trial of nasogastric feedings,

    • D.

      Plan a team meeting with the nursing home and hospice staff.

    Correct Answer
    D. Plan a team meeting with the nursing home and hospice staff.
    Explanation
    The best action for the nurse is to plan a team meeting with the nursing home and hospice staff. This allows for collaboration and discussion among the healthcare professionals involved in the patient's care. It ensures that all perspectives are considered and a consensus can be reached regarding the best course of action for the patient. This approach respects the patient's wishes as expressed in the advance directive while also addressing the staff's concerns about the patient's deteriorating condition and minimal intake.

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  • 16. 

    What ethical principle is involved when the family members of a recently diagnosed patient with pancreatic cancer request the patient not be told of the diagnosis or prognosis?

    • A.

      Veracity

    • B.

      Justice

    • C.

      Malefience

    • D.

      Confidentiality

    Correct Answer
    A. Veracity
    Explanation
    In this scenario, the ethical principle involved is veracity. Veracity refers to the obligation of healthcare professionals to be truthful and honest with their patients. By not informing the patient about their diagnosis or prognosis, the family members are withholding important information that could significantly impact the patient's decision-making and autonomy. It is crucial to respect the patient's right to know about their condition and to make informed choices about their healthcare.

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  • 17. 

    Chronic disseminated intravascular coagulopathy may be exhibited in

    • A.

      Renal failure.

    • B.

      Cardiomyopathy.

    • C.

      Huntington's disease.

    • D.

      Metastatic malignancy.

    Correct Answer
    D. Metastatic malignancy.
    Explanation
    Chronic disseminated intravascular coagulopathy is a condition characterized by abnormal blood clotting throughout the body's blood vessels. It can be caused by various underlying conditions, including metastatic malignancy. Metastatic malignancy refers to the spread of cancer from one part of the body to another. In some cases, cancer cells can release substances that activate the body's clotting system, leading to chronic disseminated intravascular coagulopathy. This condition is not typically associated with renal failure, cardiomyopathy, or Huntington's disease.

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  • 18. 

    Which of the following is the primary purpose of the Word Health Organization Analgesic Ladder for Cancer Pain Management?

    • A.

      Define steps for legalization of drugs.

    • B.

      Specify acceptable standards for drug dosage.

    • C.

      Describe interrelationships among different drugs.

    • D.

      Identify categories of drugs to be use progressively.

    Correct Answer
    D. Identify categories of drugs to be use progressively.
    Explanation
    The primary purpose of the World Health Organization Analgesic Ladder for Cancer Pain Management is to identify categories of drugs to be used progressively. The ladder provides a step-by-step approach to pain management, starting with non-opioid analgesics and progressing to opioids as necessary. This approach ensures that patients receive appropriate pain relief while minimizing the risk of side effects and addiction. By categorizing drugs and recommending their progressive use, the ladder helps healthcare professionals make informed decisions about pain management for cancer patients.

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  • 19. 

    Which of the following needs to be present for a group to be cohesive?

    • A.

      Shared focus

    • B.

      Ongoing relationships

    • C.

      Similar cultural background

    • D.

      Comparable levels of education

    Correct Answer
    A. Shared focus
    Explanation
    For a group to be cohesive, it is important to have a shared focus. This means that all members of the group should have a common goal or objective that they are working towards. When there is a shared focus, it helps to create a sense of unity and purpose within the group. It allows the members to align their efforts and work together towards achieving the desired outcome. Without a shared focus, the group may lack direction and individuals may have conflicting priorities, which can hinder their ability to work together effectively.

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  • 20. 

    A patient has metastatic lung cancer, cord compression, and a venous access device. The patient experiences tachycardia, mental status changes, rigors, and warm dry skin. These are early signs of

    • A.

      Thrombosis.

    • B.

      Dehydration.

    • C.

      Septic shock.

    • D.

      Superior vena cava syndrome.

    Correct Answer
    C. Septic shock.
    Explanation
    The given symptoms of tachycardia, mental status changes, rigors, and warm dry skin are indicative of septic shock. Septic shock occurs when an infection spreads throughout the body, leading to a systemic inflammatory response. The infection in this case may be related to the venous access device, which can introduce bacteria into the bloodstream. This can cause a severe drop in blood pressure, leading to organ dysfunction and potentially death. Therefore, septic shock is the most appropriate explanation for the given symptoms.

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  • 21. 

    Which of the following is essential in responding to a patients spiritual needs? 

    • A.

      Being available to pray with the patient.

    • B.

      Obtaining permission to contact the patient's clergy.

    • C.

      Sharing ones own spiritual beliefs with the patient.

    • D.

      Discerning when physical symptoms are indicative of spiritual concerns.

    Correct Answer
    D. Discerning when physical symptoms are indicative of spiritual concerns.
    Explanation
    In responding to a patient's spiritual needs, it is essential to discern when physical symptoms are indicative of spiritual concerns. This means being able to recognize when a patient's physical symptoms may have underlying spiritual causes or implications. This allows healthcare providers to provide appropriate support and care that addresses both the physical and spiritual aspects of the patient's well-being. By understanding the connection between physical symptoms and spiritual concerns, healthcare providers can offer holistic care that promotes the patient's overall healing and well-being.

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  • 22. 

    A 79 year old man with a history of CVA and multiple TIA's has been able to live indepensently with assistance from his family. He is hospitalized after being found walking a mile from his home, frightened and crying. He is oriented only to person. Key factor is differentiating delirium from dementia in the patient would be

    • A.

      Mood lability.

    • B.

      Diminished cognitive/intellectual abilities.

    • C.

      Rapid versus slow onset of confusion.

    • D.

      Short tem memory loss.

    Correct Answer
    C. Rapid versus slow onset of confusion.
    Explanation
    The key factor in differentiating delirium from dementia in this patient would be the rapid onset of confusion. Delirium is characterized by a sudden and fluctuating change in mental status, whereas dementia typically has a slow and progressive decline in cognitive abilities. The fact that the patient was found frightened and crying, and is only oriented to person, suggests a sudden change in mental status, indicating delirium rather than dementia. Mood lability, diminished cognitive abilities, and short-term memory loss may be present in both delirium and dementia, but the rapid onset of confusion is the most distinguishing factor in this case.

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  • 23. 

    Which of the following is usually the final physical debilitation exhibited by a patient with amyotrophic lateral sclerosis?

    • A.

      Sepsis

    • B.

      Dysphagia

    • C.

      Respiratory failure

    • D.

      Cerebral hemorrhage

    Correct Answer
    C. Respiratory failure
    Explanation
    Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. It leads to the gradual loss of muscle control and movement. As the disease progresses, the muscles responsible for breathing become weakened, leading to respiratory failure. This is usually the final physical debilitation exhibited by a patient with ALS, as the inability to breathe on their own ultimately leads to death. Sepsis, dysphagia, and cerebral hemorrhage are not typically associated with the final stages of ALS.

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  • 24. 

    A 39 year old father is dying and his wife is caring for him. His two young children are not allowed in his room. How should the interdisciplinary team proceed INITIALLY?

    • A.

      Discuss with the parents their reasons for the childrens exclusion.

    • B.

      Respect the parents wishes and refer the children to a grief group.

    • C.

      Arrange for spiritual and social work counseling for the family.

    • D.

      Have a volunteer stay with the children for a few hours.

    Correct Answer
    A. Discuss with the parents their reasons for the childrens exclusion.
    Explanation
    The interdisciplinary team should discuss with the parents their reasons for excluding the children from their father's room. This will help the team understand the parents' perspective and concerns. It will also allow the team to provide appropriate support and guidance to the parents in dealing with their children's emotions and needs during this difficult time.

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  • 25. 

    A patient with a history of ovarian cancer presents to the palliative care clinic with lower extremity swelling that started 3 days ago. The patient reports that the limb feels heavy and aches constantly. Which of the following actions should the nurse take?

    • A.

      Obtain an order for anti-embolitic stockings

    • B.

      Assess for signs and symptoms of thrombosis.

    • C.

      Instruct the patient to curtail her activity until the swelling improves.

    • D.

      Ascertain that the patient has an opiod analgesic avilable for pain management.

    Correct Answer
    B. Assess for signs and symptoms of thrombosis.
    Explanation
    The patient's history of ovarian cancer puts her at risk for developing deep vein thrombosis (DVT), which can cause lower extremity swelling, heaviness, and constant aching. Assessing for signs and symptoms of thrombosis is important to determine if the patient is experiencing a DVT. This would involve checking for warmth, redness, tenderness, and swelling in the affected limb, as well as assessing for any other signs or symptoms of a clot. This action is necessary to identify and potentially treat a serious complication in the patient's condition.

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  • 26. 

    When switching from an oxygen concertrator to a cylinder system, a patient and family should be instructed that

    • A.

      Extra cylinders should be stored in a closet.

    • B.

      Humidification is necessary with a cylinder system.

    • C.

      A lower air flow should be used with a cylinder system.

    • D.

      The guaged cylinders should be stabilized in an upright position.

    Correct Answer
    D. The guaged cylinders should be stabilized in an upright position.
    Explanation
    When switching from an oxygen concentrator to a cylinder system, it is important to instruct the patient and family that the gauged cylinders should be stabilized in an upright position. This is because the cylinders contain compressed oxygen, and if they are not stored upright, there is a risk of the oxygen leaking or becoming unstable. Stabilizing the cylinders in an upright position ensures that they are secure and reduces the risk of accidents or oxygen leakage.

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  • 27. 

    In the home setting, pain in elderly patients may be difficult to manage for which of the following reasons?

    • A.

      Sensitivity to pain decreases with age.

    • B.

      Altered pain perception is present.

    • C.

      There is a tendency to overestimate the pain.

    • D.

      Polypharmacy may interfere with medication adherence.

    Correct Answer
    D. Polypharmacy may interfere with medication adherence.
    Explanation
    Polypharmacy refers to the use of multiple medications by a patient, which can lead to medication adherence issues. Elderly patients often take multiple medications for various health conditions, and this can make it challenging to manage their pain effectively. With polypharmacy, there is a higher risk of drug interactions, side effects, and difficulties in following the medication regimen. This can result in poor pain management and decreased effectiveness of pain medications, making it difficult to manage pain in elderly patients at home.

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  • 28. 

    Which of the following treatments is MOST effective in managing discomfort related ascites?

    • A.

      Furosemide

    • B.

      Paracentesis

    • C.

      Nasogastric tube

    • D.

      Hydrochlorothiazide

    Correct Answer
    B. Paracentesis
    Explanation
    Paracentesis is the most effective treatment for managing discomfort related to ascites. Paracentesis involves the removal of excess fluid from the abdominal cavity using a needle or catheter. This procedure can provide immediate relief by reducing the pressure and discomfort caused by the accumulation of fluid. Furosemide and hydrochlorothiazide are diuretics that may be used to manage ascites, but they are not as effective as paracentesis in providing immediate relief. Nasogastric tube placement may be used to decompress the stomach in cases of gastric distension, but it is not specifically targeted at managing ascites discomfort.

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  • 29. 

    A hospice patient no longer meets medical criteria for the Medicare Hospice Benefit. The interdisciplinary team shoud FIRST

    • A.

      Wait to see if the condition changes

    • B.

      Discharge the patient to a nursing home.

    • C.

      Evaluate the patient for present care needs.

    • D.

      Discharge the patient to a home care agency.

    Correct Answer
    C. Evaluate the patient for present care needs.
    Explanation
    The correct answer is to evaluate the patient for present care needs. Once a hospice patient no longer meets the medical criteria for the Medicare Hospice Benefit, it is important for the interdisciplinary team to assess the patient's current care needs. This evaluation will help determine the appropriate course of action for the patient, whether it involves continuing hospice care, transitioning to a nursing home, or seeking care from a home care agency. It is crucial to ensure that the patient receives the appropriate level of care based on their current condition.

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  • 30. 

    Which of the following is the MOST important role of the staff nurse for a patient considering participation in an investagional treatment study?

    • A.

      Ensure protection of patient rights.

    • B.

      Obtain an informed consent for the study.

    • C.

      Determine patient eligibility for the study.

    • D.

      Exclude actively dying patients.

    Correct Answer
    A. Ensure protection of patient rights.
    Explanation
    The most important role of the staff nurse for a patient considering participation in an investigational treatment study is to ensure the protection of the patient's rights. This includes ensuring that the patient is fully informed about the study, its potential risks and benefits, and their rights as a participant. The nurse must also advocate for the patient's autonomy and ensure that they are able to make an informed decision about participation. Additionally, the nurse must ensure that the patient's privacy and confidentiality are protected throughout the study.

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  • 31. 

    In order to maintain professional boundaries, a hospice nurse should

    • A.

      Function autonomously as an interdisciplinary team member.

    • B.

      Foster close realationships with patients and families.

    • C.

      Work within defined practice guidelines.

    • D.

      Make decisions for patients when they are no longer capable.

    Correct Answer
    C. Work within defined practice guidelines.
    Explanation
    To maintain professional boundaries, a hospice nurse should work within defined practice guidelines. This means that they should follow the established rules and protocols of their profession while providing care to patients. By adhering to these guidelines, the nurse ensures that they are practicing within their scope of practice and not overstepping any boundaries. This also helps to maintain consistency and standardization in the care provided, ensuring that all patients receive the same level of quality care.

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  • 32. 

    A family has been told that a patients comatose condition will probably persist until death. The patient is still unarousable, but is now agitated and extremely restless. The family is uncertain of what to do. Which of the following is the MOST appropriate question to ask the family FIRST?  

    • A.

      When did he last urinate?

    • B.

      Does he say anything you can understand?

    • C.

      Is there anyone to whom he needs to say goodbye?

    • D.

      Has a spiritual advisor been to see him lately?

    Correct Answer
    A. When did he last urinate?
    Explanation
    The question "When did he last urinate?" is the most appropriate question to ask the family first because it can provide important information about the patient's overall health and hydration status. Changes in urinary patterns can indicate potential issues such as dehydration or kidney dysfunction, which could be contributing to the patient's agitation and restlessness. This information can help guide the family in making decisions about the patient's care and treatment.

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  • 33. 

    A patient previously receiving an extended-release phenytoin 300mg capsule by mouth at bedtime is being changed to phenytoin suspension. Which of the following is necessary at this time?

    • A.

      Adding a corticosteroid

    • B.

      Decreasing the dose of phenytoin

    • C.

      Increasing the dose of phenytoin

    • D.

      Changing the dosing interval of phenytoin

    Correct Answer
    D. Changing the dosing interval of phenytoin
    Explanation
    When switching from an extended-release capsule to a suspension, the dosing interval of phenytoin needs to be adjusted. The extended-release capsule is designed to release the medication slowly over a longer period of time, while the suspension is immediate release. Therefore, to maintain therapeutic drug levels, the dosing interval needs to be changed to ensure consistent drug absorption and effectiveness.

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  • 34. 

    How long does a Medicare-certified hospice generally provide bereavement services?

    • A.

      6 months

    • B.

      12 to 13 months

    • C.

      18 to 24 months

    • D.

      36 months

    Correct Answer
    B. 12 to 13 months
    Explanation
    A Medicare-certified hospice generally provides bereavement services for a period of 12 to 13 months. This duration allows the hospice to offer support and counseling to the family members and loved ones of the deceased during the grieving process. It gives them ample time to cope with their loss and receive the necessary emotional support.

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  • 35. 

    A patient has metastatic ovarian cancer with partial small bowel obstruction. The husband is concerned about hsi wife's ongoing fatigue and lack of energy. The patient is sleeping for long hours with frequent naps. The nurse should explain to the husband that

    • A.

      Adding an antidepressant will increase her energy level.

    • B.

      She needs to conserve her energy for those activities that she feels are most important.

    • C.

      Controlling her pain will provide more energy and will keep her awake during the day.

    • D.

      Improving her appetite and oral intake can increase her energy level.

    Correct Answer
    B. She needs to conserve her energy for those activities that she feels are most important.
    Explanation
    The correct answer is that the patient needs to conserve her energy for those activities that she feels are most important. This is because the patient has metastatic ovarian cancer with partial small bowel obstruction, which can cause fatigue and lack of energy. Sleeping for long hours and taking frequent naps is a common way for the body to conserve energy. By prioritizing and focusing on activities that are most important to her, the patient can better manage her energy levels and reduce fatigue.

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  • 36. 

    Bone metastasis should be suspected when a patient describes leg pain as  

    • A.

      Sharp, stabbing, and increasing with movement.

    • B.

      Aching, throbbing, and worsening upon movement.

    • C.

      Burning, localized and not affected by movement.

    • D.

      Cramping, generalized, and relieved with movement.

    Correct Answer
    B. Aching, throbbing, and worsening upon movement.
    Explanation
    Bone metastasis should be suspected when a patient describes leg pain as aching, throbbing, and worsening upon movement. Bone metastasis refers to the spread of cancer cells from their original site to the bones. This can cause pain in the affected bones, which is often described as aching and throbbing. The pain may worsen with movement as the bones are put under stress. This is in contrast to other types of leg pain, such as sharp, stabbing pain, which may be indicative of other conditions.

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  • 37. 

    A 54 year-old Hmong woman with end stage multiple myeloma complains of severe pain in her spine and hips. The nuse is titrating extended-release morphine to achieve better pain control, but the patients husband does not consistently follow instructions. At the last visit, the nurse notices multiple round ecchymotic spots on the patients back and recognizes this as

    • A.

      Potential physical abuse of the patient by the husband.

    • B.

      Bruising caused by myelosupression from the multiple myeloma.

    • C.

      The practice of applying suction to release evil spirits from the body.

    • D.

      The family's utilization of herbal remedies that also cause thrombocytopenia.

    Correct Answer
    C. The practice of applying suction to release evil spirits from the body.
    Explanation
    The correct answer is "the practice of applying suction to release evil spirits from the body." This is indicated by the mention of "multiple round ecchymotic spots" on the patient's back, which is a characteristic sign of cupping therapy. Cupping therapy is a traditional practice in some cultures where suction cups are applied to the skin to draw out toxins and evil spirits. In this case, it suggests that the patient may be experiencing physical abuse by her husband using this method.

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  • 38. 

    If a hospice has decided to research the effect of nebulized morphine, which of the following is the FIRST step?

    • A.

      Review previous studies.

    • B.

      Submit a research grant proposal.

    • C.

      Obtain physician approval.

    • D.

      Write an informed consent document.

    Correct Answer
    A. Review previous studies.
    Explanation
    Before conducting a research on the effect of nebulized morphine, the first step would be to review previous studies. This is important as it allows the hospice to gather existing knowledge and understanding about the subject. Reviewing previous studies helps in identifying any knowledge gaps, potential research questions, and also helps in designing the research methodology effectively. It also ensures that the hospice does not duplicate any previous research and can build upon the existing knowledge in the field.

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  • 39. 

    An example of an advance directive is the designation of which of the following?

    • A.

      A legal next of kin?

    • B.

      A healthcare surrogate?

    • C.

      An executor of the estate?

    • D.

      A preferred hospice provider?

    Correct Answer
    B. A healthcare surrogate?
    Explanation
    An advance directive is a legal document that allows an individual to specify their healthcare preferences and appoint a healthcare surrogate to make medical decisions on their behalf if they become unable to do so. Therefore, designating a healthcare surrogate is an example of an advance directive.

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  • 40. 

    A womans husband died 9 months ago after a painful illness. The womans daughter notifies the bereavement coordinator that her mother is still suffering. Which of the following statements would indicate that she is experiencing an abnormal grieving process?

    • A.

      "I visit his grave site every Sunday."

    • B.

      " I'm just no good to anyone any more."

    • C.

      "It's hard to cook for just one person."

    • D.

      "Sometimes I feel so angry at my husband."

    Correct Answer
    B. " I'm just no good to anyone any more."
    Explanation
    The statement "I'm just no good to anyone any more" indicates that the woman is experiencing an abnormal grieving process. This statement suggests that she has developed feelings of worthlessness and self-deprecation, which are not typical in the grieving process. It may indicate that she is struggling with feelings of guilt or a lack of self-worth, which could benefit from professional support and intervention.

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  • 41. 

    Which of the following is MOST commonly associated with uncontrolled pain

    • A.

      Grimacing

    • B.

      Agitation

    • C.

      Depression

    • D.

      Hallucinations

    Correct Answer
    C. Depression
    Explanation
    Uncontrolled pain is often associated with depression. When an individual is experiencing chronic pain that is not adequately managed, it can have a significant impact on their mental and emotional well-being. The constant discomfort and inability to find relief can lead to feelings of hopelessness, sadness, and frustration, which are common symptoms of depression. Additionally, the physical limitations caused by uncontrolled pain can result in social isolation and a decrease in overall quality of life, further contributing to depressive symptoms.

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  • 42. 

    Which of the following is an effective nursing measure for a patient with end stage lung cancer who has a hacking, productive cough?

    • A.

      Humidification

    • B.

      Fluid restriction

    • C.

      Supine positioning

    • D.

      Oropharygeal suctioning

    Correct Answer
    A. Humidification
    Explanation
    Humidification is an effective nursing measure for a patient with end stage lung cancer who has a hacking, productive cough. Humidification helps to add moisture to the air, which can help to soothe the airways and reduce irritation caused by coughing. It can also help to thin out mucus, making it easier to expectorate. This can provide relief for the patient and improve their comfort.

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  • 43. 

    A patient with liver cancer suddenly develops pain with nausea and vomiting. In the past 24 hours, the patients appetite has decreased. The patient cannot recall the last bowel movement. Which of the following should the nurse do FIRST?

    • A.

      Assess hydration status and consider nutritional supplements.

    • B.

      Obtain an order for an antiemetic and pain medication.

    • C.

      Perform a digital rectal examination and an abdominal assessment.

    • D.

      Obtain an order for serum electrolytes adn stimulant laxative.

    Correct Answer
    C. Perform a digital rectal examination and an abdominal assessment.
    Explanation
    The patient's symptoms of pain, nausea, vomiting, decreased appetite, and inability to recall the last bowel movement suggest a possible bowel obstruction. Performing a digital rectal examination and an abdominal assessment would help the nurse assess for any signs of obstruction, such as abdominal distension, tenderness, or palpable masses. This assessment would provide important information to guide further interventions and treatment. Assessing hydration status and considering nutritional supplements, obtaining an order for an antiemetic and pain medication, and obtaining an order for serum electrolytes and a stimulant laxative may be necessary interventions, but they should be done after the initial assessment to determine the underlying cause of the symptoms.

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  • 44. 

    A patient whose death is immeinent is experiencing periods of apnea in between deep and shallow breaths. This describes

    • A.

      Ataxic breathing.

    • B.

      Paradoxical breathing.

    • C.

      Cheyne-Stokes breathing.

    • D.

      Kussmaul-Kien respirations.

    Correct Answer
    C. Cheyne-Stokes breathing.
    Explanation
    Cheyne-Stokes breathing is a pattern of breathing characterized by alternating periods of deep and shallow breaths, with periods of apnea in between. It is commonly seen in patients who are near death or have severe neurological damage. Ataxic breathing refers to an irregular and uncoordinated breathing pattern. Paradoxical breathing refers to abnormal chest movement during respiration. Kussmaul-Kien respirations are deep, rapid, and labored breaths seen in patients with metabolic acidosis.

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  • 45. 

    A nurse is making an inital home visit with a patient and the family. The family recently moved to the US from Asia. Which of the following MOST likely characterizes the use of social touch in the care of this patient and family?

    • A.

      Social touch by staff members may be viewed as inappropriate.

    • B.

      Treatment wil not be valued unless social touch is also involved.

    • C.

      Social Touch with the patient is acceptable, but not with the family.

    • D.

      Social touch is only acceptable between patients and staff of the same gender.

    Correct Answer
    D. Social touch is only acceptable between patients and staff of the same gender.
  • 46. 

    Which of the following nonpharmacologic interventions is MOST appropriate for management of diffuse bone pain?

    • A.

      Deep muscle massage

    • B.

      Compression stockings

    • C.

      Relaxation techniques

    • D.

      Passive range of motion

    Correct Answer
    C. Relaxation techniques
    Explanation
    Relaxation techniques are the most appropriate nonpharmacologic intervention for managing diffuse bone pain. Relaxation techniques such as deep breathing, meditation, and guided imagery can help reduce stress and promote a sense of calm, which can in turn help alleviate pain. These techniques are noninvasive and have minimal side effects, making them a safe and effective option for managing diffuse bone pain. Deep muscle massage, compression stockings, and passive range of motion may be helpful for other types of pain or conditions, but they may not specifically target diffuse bone pain.

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  • 47. 

    An important role of antinoeplastic drugs in palliative care is to

    • A.

      Maintain hope for remission.

    • B.

      Promote improved immune responses.

    • C.

      Decrease side effects of treatments.

    • D.

      Reduce tumor mass to relieve symptoms.

    Correct Answer
    D. Reduce tumor mass to relieve symptoms.
    Explanation
    Antineoplastic drugs are used in palliative care to reduce tumor mass, which helps relieve symptoms such as pain and discomfort. These drugs work by targeting and destroying cancer cells, thereby shrinking the tumor and alleviating the associated symptoms. While they may not necessarily lead to remission or improved immune responses, their primary goal is to provide relief and improve the quality of life for patients in palliative care.

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  • 48. 

    Which of the following is MOST likely occurring when an activley dying patient begins to limit interpersonal involvement?

    • A.

      An expression of anger

    • B.

      A demonstration of depression

    • C.

      An attempt to conserve time and energy

    • D.

      An indirect request for support and attention

    Correct Answer
    C. An attempt to conserve time and energy
    Explanation
    When an actively dying patient begins to limit interpersonal involvement, it is most likely an attempt to conserve time and energy. This can be understood as the patient's way of prioritizing their physical and emotional resources as they near the end of their life. By reducing their interpersonal interactions, they can focus on preserving their energy for essential tasks and personal needs. This behavior is commonly observed in patients who are actively dying and is a natural response to the physical and emotional demands of their condition.

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  • 49. 

    An active, 72 year old women with breast cancer has sudden onset of lethargy, nausea, constipation, and complains of increased leg pain. Which of the following would be the BEST INITIAL action by the nurse?

    • A.

      Change the analegesic agent.

    • B.

      Assess the bowel management regimen.

    • C.

      Request an order for a calcium level.

    • D.

      Assess the caregiver's compliance in the provision of medications.

    Correct Answer
    C. Request an order for a calcium level.
    Explanation
    The sudden onset of lethargy, nausea, constipation, and increased leg pain in a 72-year-old woman with breast cancer suggests a possible hypercalcemia. Hypercalcemia is a common complication of advanced cancer and can cause these symptoms. Requesting an order for a calcium level would be the best initial action by the nurse to assess for hypercalcemia and determine appropriate interventions. Changing the analgesic agent, assessing the bowel management regimen, or assessing the caregiver's compliance with medication provision may be necessary interventions, but they are not the best initial action in this case.

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  • 50. 

    Bladder spasms secodary to bladder cancer are MOST effectively relieved by

    • A.

      Morphine.

    • B.

      Belladonna.

    • C.

      Baclofen.

    • D.

      Indomethacin.

    Correct Answer
    B. Belladonna.
    Explanation
    Bladder spasms secondary to bladder cancer are most effectively relieved by belladonna. Belladonna, also known as deadly nightshade, contains alkaloids that have antispasmodic properties. These alkaloids help to relax the smooth muscles of the bladder, relieving the spasms. Morphine is a potent analgesic that can help with pain relief, but it may not be as effective in relieving bladder spasms. Baclofen is a muscle relaxant that is commonly used for conditions such as multiple sclerosis, but it may not specifically target bladder spasms caused by bladder cancer. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that can help with pain and inflammation, but it may not directly address the spasms. Therefore, belladonna is the most effective option for relieving bladder spasms in this scenario.

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Quiz Review Timeline +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Aug 30, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • May 06, 2014
    Quiz Created by
    Croman
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