ADVANCED CERTIFIED HOSPICE AND PALLIATIVE
NURSE (ACHPN)Final EXAM WITH CORRECT ACTUAL
QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+
,Domain 1: Pain and Symptom Management
1. A patient with advanced pancreatic cancer reports dull, constant epigastric pain radiating to the back, rated
7/10. Which analgesic approach is most appropriate first-line?
A) Short-acting opioid for breakthrough pain only
B) Around-the-clock (ATC) long-acting opioid plus a short-acting opioid for breakthrough pain
C) Acetaminophen around the clock
D) Immediate-release opioid only as needed
Answer: B
Rationale: For continuous, moderate-to-severe cancer-related pain, scheduled ATC dosing of a long-acting
opioid provides consistent analgesia. A short-acting opioid must also be provided for breakthrough pain (rescue
doses). Option A treats only episodic pain; option C is insufficient for severe pain; option D provides no baseline
coverage.
2. A patient on hydromorphone develops myoclonus. What is the most appropriate initial intervention?
A) Add a benzodiazepine immediately
B) Increase the hydromorphone dose to cover the myoclonus
C) Switch to a different opioid (opioid rotation)
,D) Discontinue all opioids and use non-pharmacological methods only
Answer: C
Rationale: Myoclonus is a neurotoxic side effect of opioids, particularly with high doses or accumulating
metabolites. While benzodiazepines can treat the symptom, the underlying cause is opioid neurotoxicity. The
standard of care is to rotate to a different opioid (e.g., from hydromorphone to fentanyl or methadone), which
often resolves the symptom.
3. A dying patient develops noisy, wet-sounding respirations ("death rattle"). The family is distressed. What is the
first-line pharmacological management?
A) Suctioning the airway
B) Anticholinergic medication (e.g., glycopyrrolate)
C) IV diuretic (e.g., furosemide)
D) Broad-spectrum antibiotics
Answer: B
Rationale: Death rattle is caused by the inability to clear salivary and bronchial secretions, not by pulmonary
edema or infection. First-line treatment is an anticholinergic agent like glycopyrrolate or scopolamine to dry
secretions. Suctioning is often ineffective and can cause distress. Repositioning the patient can also help.
, 4. A patient with a history of substance use disorder and metastatic cancer has severe pain. What is the core
principle of pain management for this patient?
A) Limit opioid use strictly to oral, non-abusable formulations
B) Treat the pain aggressively using a multimodal approach, including opioids and strict monitoring/contracts
C) Avoid all opioids and use interventional procedures only
D) Provide only non-opioid adjuvant medications regardless of pain level
Answer: B
Rationale: Patients with a history of substance use disorder have a right to effective pain relief. The standard of
care is a multimodal approach, which may include opioids if indicated, combined with clear boundaries, a
universal precautions approach, frequent monitoring, a treatment agreement, and involvement of addiction
specialists. Denying opioids is unethical and can lead to undertreated pain and pseudo-addiction.
5. A patient with a complete bowel obstruction from ovarian cancer has intractable nausea and vomiting. Which
antiemetic acts directly at the chemoreceptor trigger zone and also slows GI secretions, making it particularly
useful?
A) Ondansetron
B) Prochlorperazine
C) Octreotide
D) Metoclopramide
NURSE (ACHPN)Final EXAM WITH CORRECT ACTUAL
QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+
,Domain 1: Pain and Symptom Management
1. A patient with advanced pancreatic cancer reports dull, constant epigastric pain radiating to the back, rated
7/10. Which analgesic approach is most appropriate first-line?
A) Short-acting opioid for breakthrough pain only
B) Around-the-clock (ATC) long-acting opioid plus a short-acting opioid for breakthrough pain
C) Acetaminophen around the clock
D) Immediate-release opioid only as needed
Answer: B
Rationale: For continuous, moderate-to-severe cancer-related pain, scheduled ATC dosing of a long-acting
opioid provides consistent analgesia. A short-acting opioid must also be provided for breakthrough pain (rescue
doses). Option A treats only episodic pain; option C is insufficient for severe pain; option D provides no baseline
coverage.
2. A patient on hydromorphone develops myoclonus. What is the most appropriate initial intervention?
A) Add a benzodiazepine immediately
B) Increase the hydromorphone dose to cover the myoclonus
C) Switch to a different opioid (opioid rotation)
,D) Discontinue all opioids and use non-pharmacological methods only
Answer: C
Rationale: Myoclonus is a neurotoxic side effect of opioids, particularly with high doses or accumulating
metabolites. While benzodiazepines can treat the symptom, the underlying cause is opioid neurotoxicity. The
standard of care is to rotate to a different opioid (e.g., from hydromorphone to fentanyl or methadone), which
often resolves the symptom.
3. A dying patient develops noisy, wet-sounding respirations ("death rattle"). The family is distressed. What is the
first-line pharmacological management?
A) Suctioning the airway
B) Anticholinergic medication (e.g., glycopyrrolate)
C) IV diuretic (e.g., furosemide)
D) Broad-spectrum antibiotics
Answer: B
Rationale: Death rattle is caused by the inability to clear salivary and bronchial secretions, not by pulmonary
edema or infection. First-line treatment is an anticholinergic agent like glycopyrrolate or scopolamine to dry
secretions. Suctioning is often ineffective and can cause distress. Repositioning the patient can also help.
, 4. A patient with a history of substance use disorder and metastatic cancer has severe pain. What is the core
principle of pain management for this patient?
A) Limit opioid use strictly to oral, non-abusable formulations
B) Treat the pain aggressively using a multimodal approach, including opioids and strict monitoring/contracts
C) Avoid all opioids and use interventional procedures only
D) Provide only non-opioid adjuvant medications regardless of pain level
Answer: B
Rationale: Patients with a history of substance use disorder have a right to effective pain relief. The standard of
care is a multimodal approach, which may include opioids if indicated, combined with clear boundaries, a
universal precautions approach, frequent monitoring, a treatment agreement, and involvement of addiction
specialists. Denying opioids is unethical and can lead to undertreated pain and pseudo-addiction.
5. A patient with a complete bowel obstruction from ovarian cancer has intractable nausea and vomiting. Which
antiemetic acts directly at the chemoreceptor trigger zone and also slows GI secretions, making it particularly
useful?
A) Ondansetron
B) Prochlorperazine
C) Octreotide
D) Metoclopramide
