Hospice and palliative RegisteRed nuRse
ceRtification exam 100% veRified Rated a+
Which assessment findings would most strongly suggest an issue with morphine? Correct -myoclonus is
a symptom of the toxic effects of morphine metabolites
Which cancer is least likely to metastasize to the bone? Correct -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?
Correct -morphine; opioids provide palliative support for symptoms of breathlessness or suffocation.
What is not an appropriate intervention for a bowel obstruction Correct -Metoclopramide
The classic signs of superior vena cava syndrome (SVCS) Correct -facial edema, dyspnea, edematous arms
w/bluish color=this is oncologic emergency requiring immediate attention.
anticipatory grief Correct -the proces of psychological, social, and somatic reactions to a perceived future
loss.
signs and symptoms of imminent death Correct -dysphagia
stage II skin breakdown Correct -skin is blistered, cracked or abraded
The state of having suffered a loss Correct -bereavement
Disseminated Intravascular Coagulation (DIC) Correct -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 Correct -teach family the importance of oral
hygiene to prevent complications such as mouth soreness and infections.
,safety is a priority w/persons w/dementia Correct -supervision, minimal stimulation, and discouraging
sleep during daytime hours maximize night safety.
xerostomia Correct -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 Correct -identifies and strives to relieve the spiritual
suffering of the patient and family
Grief Correct -the feelings related to the perception of the loss and is a normal reaction to loss.
mentoring Correct -a relationship between an experienced person and a less experienced person
Justice Correct -to consider rules and actions that result in fair and equitable use of available resources.
medicare hospice benefit periods Correct -90-, 90-, and unlimited 60-day periods
crossing of professional boundaries Correct -providing a personal cell phone number to the family
syncopal episodes and falls Correct -consider discontinuing antihypertensive medications if blood
pressure is consistently low
When revoking the medicare hospice benefit Correct -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 Correct -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 Correct -knowing how
the family makes decisions and who the decision makers are is priority.
, therapy for stage II wounds Correct -relieve pressure and apply protective/occlusive dressings.
starting oral dose for methadone Correct -2.5-5 mg every 8 hours (half dose for elderly or severe renal or
liver disease)
side effect of methadone Correct -prolong QT interval
equianalgesic conversion process -step one Correct -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 Correct -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.
equianalgesic conversion process- step three Correct -Multiply the step 2 number by the equianalgesic
value for the new drug and route (this will give you the new 24-hour dose
equianalgesic conversion process-step four Correct -Determine how many doses the patient will take
each day and divide this number into the total 24-hour dose (this gives the amount of medication
needed per dose)
ceRtification exam 100% veRified Rated a+
Which assessment findings would most strongly suggest an issue with morphine? Correct -myoclonus is
a symptom of the toxic effects of morphine metabolites
Which cancer is least likely to metastasize to the bone? Correct -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?
Correct -morphine; opioids provide palliative support for symptoms of breathlessness or suffocation.
What is not an appropriate intervention for a bowel obstruction Correct -Metoclopramide
The classic signs of superior vena cava syndrome (SVCS) Correct -facial edema, dyspnea, edematous arms
w/bluish color=this is oncologic emergency requiring immediate attention.
anticipatory grief Correct -the proces of psychological, social, and somatic reactions to a perceived future
loss.
signs and symptoms of imminent death Correct -dysphagia
stage II skin breakdown Correct -skin is blistered, cracked or abraded
The state of having suffered a loss Correct -bereavement
Disseminated Intravascular Coagulation (DIC) Correct -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 Correct -teach family the importance of oral
hygiene to prevent complications such as mouth soreness and infections.
,safety is a priority w/persons w/dementia Correct -supervision, minimal stimulation, and discouraging
sleep during daytime hours maximize night safety.
xerostomia Correct -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 Correct -identifies and strives to relieve the spiritual
suffering of the patient and family
Grief Correct -the feelings related to the perception of the loss and is a normal reaction to loss.
mentoring Correct -a relationship between an experienced person and a less experienced person
Justice Correct -to consider rules and actions that result in fair and equitable use of available resources.
medicare hospice benefit periods Correct -90-, 90-, and unlimited 60-day periods
crossing of professional boundaries Correct -providing a personal cell phone number to the family
syncopal episodes and falls Correct -consider discontinuing antihypertensive medications if blood
pressure is consistently low
When revoking the medicare hospice benefit Correct -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 Correct -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 Correct -knowing how
the family makes decisions and who the decision makers are is priority.
, therapy for stage II wounds Correct -relieve pressure and apply protective/occlusive dressings.
starting oral dose for methadone Correct -2.5-5 mg every 8 hours (half dose for elderly or severe renal or
liver disease)
side effect of methadone Correct -prolong QT interval
equianalgesic conversion process -step one Correct -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 Correct -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.
equianalgesic conversion process- step three Correct -Multiply the step 2 number by the equianalgesic
value for the new drug and route (this will give you the new 24-hour dose
equianalgesic conversion process-step four Correct -Determine how many doses the patient will take
each day and divide this number into the total 24-hour dose (this gives the amount of medication
needed per dose)
