certified hospice palliative nurse CHPN
exam
AIDS infection - AnswerBacterial, Viral, Fungal, Parasitic
AIDS dementia - Answercauses Encephalopathy, 15% effected
ALS (amyotrophic lateral sclerosis) 1st symptom - Answerswallowing difficulty
followed by distal weakness
Cerebral Metastases - AnswerBrain mets account for 40% of all Cancer patients.
Cerebral Metastases symptoms - AnswerHA initial complaint, N/V, confusion, lethargy
Leukemia 2 types - Answerchronic and acute
Leukemia Clinical Manifestations - AnswerInfection, fever, enlarged liver, spleen,
kidneys, bleeding/bruising not explained, & hemorrhage
pale, petechia, purpura
liver failure symptoms - Answerfatigue, jaundice, ascites
Dark urine, gray stool, bruising
symptoms of bleeding internally - Answersudden fever > 101°, dyspnea, abdominal
paik, dehydration
Lymphoma types - AnswerHodgkins and Non-Hodgkins
Hodgkin's disease - Answerpainless lymph node swelling, generally in upper body,
general fatigue, weight loss, fever, nifht sweats, back pain
Non-Hodgkin's Lymphoma - Answersame symptoms except itching & night sweats
Parkinson's disease - AnswerSlow progression of motor skills, resting tremors,
slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - Answerpill rolling movements in bands, loss of facial
expression, difficulty initiating movement, gait changes
Renal Cancer/symptoms - Answerasymptomatic early. Gross hematuria, dull, aching
pain, palpable abdomen mass.
,polycythemia- HA, dizzy, vein inflammation, itchy. hypercalcemia- tired, poor appetite,
freq. urine, thirst, n/v, confusion, constipation, poor concentration
sickle cell disease - Answerpallor, jaundice, weakness, fatigue common symptoms
sickle cell crisis - Answermultiple pain events, pale lips, tongje, palms, nail beds,
lethargy, difficulty arousing, high fever 2 days
sickle cell risk - Answerhigh r/o bacterial infections
palliative sedation - Answermidazolam, propofol
terminal weaning - Answergradual withdrawal of mechanical ventilation
terminal Extubation - Answerabrupt Removal of endotracheal tube
Death Rattle Meds - Answeranticholinergic should be given @ 1st site of moisture.
they cannot dry up secretions already present
poverty barriers at EOL - Answeradditional challenges to EOL care. lack of support.
BIPAP (non-invasive ventilation) - Answermay be utilized at EOL for dyspnea in some
pts who do not want to be intubated for RF but want something more than supplemental
o2.
ALS has been shown to improve quality of life.
unhealthy coping in caregiver @ EOL - Answersigns: negative feelings (anger),
withholding info to other family, refusing assistance, focusing on their needs only,
refusing to acknowledge or accommodate differences in opinion among caregivers.
intervene with assistance/resources
tricyclic antidepressants - Answertx neuropathic pain. High A/E
tricyclic antidepressants A/E - AnswerAnticholinergic common: dry mouth, urinary
retention, tachycardia, delirium, constipation
additional: arrhythmias, sedation, weight gain, sweating, sexual dysfunction.
*pt may refuse to continue r/t A/E
myoclonus - Answerjerks, sudden, brief, and uncontrollable movement. mostly upper
extremity. most common cause is opiod. sign of opiod toxicity- need to change meds.
Narcan for acute tx.
benzos & antispasmodics can be tx in *some* pts
, Hypercalcemia - Answerurgent & serious late stage malignancy (unrelated to bone
mets). no tx results in death
hypercalcemia occurrence - Answermost common breast CA & multiple myeloma but
can occur with others.
Hypercalcemia symptoms - Answern/v, constipation, anorexia
weakness, mental change, fatigue
bradycardia, EKG changes
Hypercalcemia treatment - Answerpalliative care pt: IV hydration, calcitonin (inhibits
bone resorption) & biophonates (inhibits bone resorption & reduces Calcium levels)- but
this is delayed to 48 hrs after administration.
federal law & organ donation - Answerfamily must be asked about donation when pts
die in the hospital if there is no advanced directive outlining pts wishes
Xerostomia- what is is/test - Answerpasty, thick saliva
cracker test: give pt cracker to eat. if pt is unable to chew & swallow w/out liquid, then
test is +
tongue blade: place on pt tongue & if it sticks- +
measurement of saliva- sawb or pt spits into container for period of time
lack of radial pulse - Answerdeath likely to occur in a few hrs
Byrock & Merrimans EOL construct - Answer6 dimensions- apply to pt & caregiver
byrock & merrimans EOL dimensions - Answerwell-being: subjective feelings about
condition, emotions (anxiety, fear, readiness, acceptance)
physical: comfort level & physical distress
function: ability to carry out ADLs
interpersonal: degree/quality relationships & changes from caregiving
transcedent: perception of meaning of life as well as spiritual/religious values
*a change in 1 dimension affects other dimensions. ex: ^ pain= dec. function
tasks associated with accepting finality of life - Answeremotional withdrawal
(decathexis). dependency & acknowledging feelings of personal loss/impending death.
new self- accepts they have value
personal meaning for life- life review, sharing stories, person love/forgiveness of self
harpers stages - Answer1) Intellectualism (0-3 months): may feel anxiety while
learning/superficial acceptance
2) emotional survival (3-6 months): over identify w/ pts situation & explore ^ discomfort,
guilt, saddness, ^ emotional involvement
exam
AIDS infection - AnswerBacterial, Viral, Fungal, Parasitic
AIDS dementia - Answercauses Encephalopathy, 15% effected
ALS (amyotrophic lateral sclerosis) 1st symptom - Answerswallowing difficulty
followed by distal weakness
Cerebral Metastases - AnswerBrain mets account for 40% of all Cancer patients.
Cerebral Metastases symptoms - AnswerHA initial complaint, N/V, confusion, lethargy
Leukemia 2 types - Answerchronic and acute
Leukemia Clinical Manifestations - AnswerInfection, fever, enlarged liver, spleen,
kidneys, bleeding/bruising not explained, & hemorrhage
pale, petechia, purpura
liver failure symptoms - Answerfatigue, jaundice, ascites
Dark urine, gray stool, bruising
symptoms of bleeding internally - Answersudden fever > 101°, dyspnea, abdominal
paik, dehydration
Lymphoma types - AnswerHodgkins and Non-Hodgkins
Hodgkin's disease - Answerpainless lymph node swelling, generally in upper body,
general fatigue, weight loss, fever, nifht sweats, back pain
Non-Hodgkin's Lymphoma - Answersame symptoms except itching & night sweats
Parkinson's disease - AnswerSlow progression of motor skills, resting tremors,
slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - Answerpill rolling movements in bands, loss of facial
expression, difficulty initiating movement, gait changes
Renal Cancer/symptoms - Answerasymptomatic early. Gross hematuria, dull, aching
pain, palpable abdomen mass.
,polycythemia- HA, dizzy, vein inflammation, itchy. hypercalcemia- tired, poor appetite,
freq. urine, thirst, n/v, confusion, constipation, poor concentration
sickle cell disease - Answerpallor, jaundice, weakness, fatigue common symptoms
sickle cell crisis - Answermultiple pain events, pale lips, tongje, palms, nail beds,
lethargy, difficulty arousing, high fever 2 days
sickle cell risk - Answerhigh r/o bacterial infections
palliative sedation - Answermidazolam, propofol
terminal weaning - Answergradual withdrawal of mechanical ventilation
terminal Extubation - Answerabrupt Removal of endotracheal tube
Death Rattle Meds - Answeranticholinergic should be given @ 1st site of moisture.
they cannot dry up secretions already present
poverty barriers at EOL - Answeradditional challenges to EOL care. lack of support.
BIPAP (non-invasive ventilation) - Answermay be utilized at EOL for dyspnea in some
pts who do not want to be intubated for RF but want something more than supplemental
o2.
ALS has been shown to improve quality of life.
unhealthy coping in caregiver @ EOL - Answersigns: negative feelings (anger),
withholding info to other family, refusing assistance, focusing on their needs only,
refusing to acknowledge or accommodate differences in opinion among caregivers.
intervene with assistance/resources
tricyclic antidepressants - Answertx neuropathic pain. High A/E
tricyclic antidepressants A/E - AnswerAnticholinergic common: dry mouth, urinary
retention, tachycardia, delirium, constipation
additional: arrhythmias, sedation, weight gain, sweating, sexual dysfunction.
*pt may refuse to continue r/t A/E
myoclonus - Answerjerks, sudden, brief, and uncontrollable movement. mostly upper
extremity. most common cause is opiod. sign of opiod toxicity- need to change meds.
Narcan for acute tx.
benzos & antispasmodics can be tx in *some* pts
, Hypercalcemia - Answerurgent & serious late stage malignancy (unrelated to bone
mets). no tx results in death
hypercalcemia occurrence - Answermost common breast CA & multiple myeloma but
can occur with others.
Hypercalcemia symptoms - Answern/v, constipation, anorexia
weakness, mental change, fatigue
bradycardia, EKG changes
Hypercalcemia treatment - Answerpalliative care pt: IV hydration, calcitonin (inhibits
bone resorption) & biophonates (inhibits bone resorption & reduces Calcium levels)- but
this is delayed to 48 hrs after administration.
federal law & organ donation - Answerfamily must be asked about donation when pts
die in the hospital if there is no advanced directive outlining pts wishes
Xerostomia- what is is/test - Answerpasty, thick saliva
cracker test: give pt cracker to eat. if pt is unable to chew & swallow w/out liquid, then
test is +
tongue blade: place on pt tongue & if it sticks- +
measurement of saliva- sawb or pt spits into container for period of time
lack of radial pulse - Answerdeath likely to occur in a few hrs
Byrock & Merrimans EOL construct - Answer6 dimensions- apply to pt & caregiver
byrock & merrimans EOL dimensions - Answerwell-being: subjective feelings about
condition, emotions (anxiety, fear, readiness, acceptance)
physical: comfort level & physical distress
function: ability to carry out ADLs
interpersonal: degree/quality relationships & changes from caregiving
transcedent: perception of meaning of life as well as spiritual/religious values
*a change in 1 dimension affects other dimensions. ex: ^ pain= dec. function
tasks associated with accepting finality of life - Answeremotional withdrawal
(decathexis). dependency & acknowledging feelings of personal loss/impending death.
new self- accepts they have value
personal meaning for life- life review, sharing stories, person love/forgiveness of self
harpers stages - Answer1) Intellectualism (0-3 months): may feel anxiety while
learning/superficial acceptance
2) emotional survival (3-6 months): over identify w/ pts situation & explore ^ discomfort,
guilt, saddness, ^ emotional involvement
