CHPN® ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Domain 1: Pain Management (22%)
Question 1
A patient with advanced cancer is receiving morphine for severe pain. The patient reports
constipation. Which intervention should the nurse prioritize to manage opioid-induced
constipation?
A) Increase the morphine dose to improve pain control.
B) Recommend a high-fiber diet and increased fluid intake.
C) Administer a prescribed stimulant laxative and stool softener.
D) Discontinue the morphine to prevent further constipation.
Answer: C) Administer a prescribed stimulant laxative and stool softener.
Rationale: Opioid-induced constipation is a predictable and common side effect that requires
proactive management. A bowel regimen, including a stimulant laxative (e.g., senna) and a stool
softener (e.g., docusate), is the standard first-line treatment. Dietary changes alone are
insufficient for managing this side effect. Changing the morphine dose is not the priority;
managing the constipation is.
Question 2
A patient is experiencing neuropathic pain. Which of the following medications is most
appropriate for treating this type of pain?
A) Ibuprofen
B) Acetaminophen
C) Gabapentin
D) Morphine
,Answer: C) Gabapentin.
Rationale: Neuropathic pain, which arises from nerve damage, responds poorly to traditional
analgesics like NSAIDs and opioids. Adjuvant medications such as gabapentin or pregabalin are
considered first-line treatments for neuropathic pain. Morphine can be used but typically
requires higher doses and is often combined with adjuvants for neuropathic pain.
Question 3
A patient with bone metastases reports severe, aching pain that worsens with movement.
Which class of medication is most appropriate as an adjunct to opioid therapy?
A) Antidepressants
B) Anticonvulsants
C) Bisphosphonates
D) Corticosteroids
Answer: C) Bisphosphonates.
Rationale: Bone pain from metastases often responds to bisphosphonates (e.g., zoledronic acid,
pamidronate) and corticosteroids, which reduce tumor-associated inflammation and bone
destruction. Anticonvulsants and antidepressants are more appropriate for neuropathic pain.
Bisphosphonates are specific to bone pain management.
Question 4
The nurse is assessing a patient's pain. Which statement reflects the most accurate
understanding of pain assessment?
A) "Pain is whatever the patient says it is."
B) "Pain is primarily a physical phenomenon."
C) "Pain can be measured objectively."
D) "Pain is always related to tissue damage."
Answer: A) "Pain is whatever the patient says it is."
Rationale: Pain is subjective. The patient's self-report is the gold standard for assessment. The
nurse should accept the patient's report and treat accordingly. Pain has physical, psychological,
social, and spiritual components.
,Question 5
A patient is receiving a continuous morphine infusion via PCA. The patient's respiratory rate is 8
breaths/min and the patient is difficult to arouse. Which intervention is a priority?
A) Administer naloxone
B) Discontinue the PCA infusion
C) Notify the provider
D) All of the above
Answer: D) All of the above.
Rationale: The patient is showing signs of respiratory depression due to opioid overdose. The
nurse should discontinue the PCA infusion, administer naloxone if ordered, and notify the
provider. The priority is to support the patient's airway and breathing.
Question 6
A patient with cancer pain is receiving a fentanyl patch. Which instruction should the nurse
include in the teaching plan?
A) "Apply the patch to a new site each time."
B) "Cut the patch in half if pain is controlled."
C) "Avoid applying heat over the patch."
D) "Change the patch daily."
Answer: C) "Avoid applying heat over the patch."
Rationale: Fentanyl patch absorption increases with heat, which can cause a dangerous
overdose. The patch should be applied to a clean, dry, hairless site and changed every 72 hours.
It should never be cut, as this can alter absorption. Sites should be rotated to prevent skin
irritation.
Question 7
A patient is experiencing breakthrough pain. The nurse should recognize that breakthrough pain
is:
A) Pain that occurs despite around-the-clock analgesics
B) Pain that occurs only at the end of life
C) Pain that does not respond to any medication
D) Pain that requires increasing the around-the-clock dose
, Answer: A) Pain that occurs despite around-the-clock analgesics.
Rationale: Breakthrough pain is a transient exacerbation of pain that occurs despite stable
around-the-clock analgesic therapy. It is treated with short-acting opioid medications. It is not
limited to the end of life and does not necessarily indicate that the baseline dose is insufficient.
Question 8
A patient with a history of substance use disorder is experiencing pain. The nurse should:
A) Withhold opioids to prevent addiction
B) Use non-pharmacologic interventions only
C) Assess the pain and treat it appropriately
D) Consult psychiatry before administering opioids
Answer: C) Assess the pain and treat it appropriately.
Rationale: Patients with a history of substance use disorder deserve the same approach to pain
management as other patients. The nurse should assess pain, use a multimodal approach, and
administer medications as ordered. Addiction risk should be considered but does not preclude
appropriate pain management.
Question 9
The nurse is evaluating the effectiveness of pain management. Which finding indicates the pain
regimen is effective?
A) The patient reports pain is 3 out of 10
B) The patient is sleeping through the night
C) The patient reports improved function and comfort
D) All of the above
Answer: D) All of the above.
Rationale: Pain management effectiveness is evaluated by a combination of factors: pain rating,
sleep quality, function, and overall comfort. The patient's report of improved comfort and
function is a positive indicator of effective pain management.
Question 10
Which of the following best describes the role of adjuvant analgesics in pain management?
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Domain 1: Pain Management (22%)
Question 1
A patient with advanced cancer is receiving morphine for severe pain. The patient reports
constipation. Which intervention should the nurse prioritize to manage opioid-induced
constipation?
A) Increase the morphine dose to improve pain control.
B) Recommend a high-fiber diet and increased fluid intake.
C) Administer a prescribed stimulant laxative and stool softener.
D) Discontinue the morphine to prevent further constipation.
Answer: C) Administer a prescribed stimulant laxative and stool softener.
Rationale: Opioid-induced constipation is a predictable and common side effect that requires
proactive management. A bowel regimen, including a stimulant laxative (e.g., senna) and a stool
softener (e.g., docusate), is the standard first-line treatment. Dietary changes alone are
insufficient for managing this side effect. Changing the morphine dose is not the priority;
managing the constipation is.
Question 2
A patient is experiencing neuropathic pain. Which of the following medications is most
appropriate for treating this type of pain?
A) Ibuprofen
B) Acetaminophen
C) Gabapentin
D) Morphine
,Answer: C) Gabapentin.
Rationale: Neuropathic pain, which arises from nerve damage, responds poorly to traditional
analgesics like NSAIDs and opioids. Adjuvant medications such as gabapentin or pregabalin are
considered first-line treatments for neuropathic pain. Morphine can be used but typically
requires higher doses and is often combined with adjuvants for neuropathic pain.
Question 3
A patient with bone metastases reports severe, aching pain that worsens with movement.
Which class of medication is most appropriate as an adjunct to opioid therapy?
A) Antidepressants
B) Anticonvulsants
C) Bisphosphonates
D) Corticosteroids
Answer: C) Bisphosphonates.
Rationale: Bone pain from metastases often responds to bisphosphonates (e.g., zoledronic acid,
pamidronate) and corticosteroids, which reduce tumor-associated inflammation and bone
destruction. Anticonvulsants and antidepressants are more appropriate for neuropathic pain.
Bisphosphonates are specific to bone pain management.
Question 4
The nurse is assessing a patient's pain. Which statement reflects the most accurate
understanding of pain assessment?
A) "Pain is whatever the patient says it is."
B) "Pain is primarily a physical phenomenon."
C) "Pain can be measured objectively."
D) "Pain is always related to tissue damage."
Answer: A) "Pain is whatever the patient says it is."
Rationale: Pain is subjective. The patient's self-report is the gold standard for assessment. The
nurse should accept the patient's report and treat accordingly. Pain has physical, psychological,
social, and spiritual components.
,Question 5
A patient is receiving a continuous morphine infusion via PCA. The patient's respiratory rate is 8
breaths/min and the patient is difficult to arouse. Which intervention is a priority?
A) Administer naloxone
B) Discontinue the PCA infusion
C) Notify the provider
D) All of the above
Answer: D) All of the above.
Rationale: The patient is showing signs of respiratory depression due to opioid overdose. The
nurse should discontinue the PCA infusion, administer naloxone if ordered, and notify the
provider. The priority is to support the patient's airway and breathing.
Question 6
A patient with cancer pain is receiving a fentanyl patch. Which instruction should the nurse
include in the teaching plan?
A) "Apply the patch to a new site each time."
B) "Cut the patch in half if pain is controlled."
C) "Avoid applying heat over the patch."
D) "Change the patch daily."
Answer: C) "Avoid applying heat over the patch."
Rationale: Fentanyl patch absorption increases with heat, which can cause a dangerous
overdose. The patch should be applied to a clean, dry, hairless site and changed every 72 hours.
It should never be cut, as this can alter absorption. Sites should be rotated to prevent skin
irritation.
Question 7
A patient is experiencing breakthrough pain. The nurse should recognize that breakthrough pain
is:
A) Pain that occurs despite around-the-clock analgesics
B) Pain that occurs only at the end of life
C) Pain that does not respond to any medication
D) Pain that requires increasing the around-the-clock dose
, Answer: A) Pain that occurs despite around-the-clock analgesics.
Rationale: Breakthrough pain is a transient exacerbation of pain that occurs despite stable
around-the-clock analgesic therapy. It is treated with short-acting opioid medications. It is not
limited to the end of life and does not necessarily indicate that the baseline dose is insufficient.
Question 8
A patient with a history of substance use disorder is experiencing pain. The nurse should:
A) Withhold opioids to prevent addiction
B) Use non-pharmacologic interventions only
C) Assess the pain and treat it appropriately
D) Consult psychiatry before administering opioids
Answer: C) Assess the pain and treat it appropriately.
Rationale: Patients with a history of substance use disorder deserve the same approach to pain
management as other patients. The nurse should assess pain, use a multimodal approach, and
administer medications as ordered. Addiction risk should be considered but does not preclude
appropriate pain management.
Question 9
The nurse is evaluating the effectiveness of pain management. Which finding indicates the pain
regimen is effective?
A) The patient reports pain is 3 out of 10
B) The patient is sleeping through the night
C) The patient reports improved function and comfort
D) All of the above
Answer: D) All of the above.
Rationale: Pain management effectiveness is evaluated by a combination of factors: pain rating,
sleep quality, function, and overall comfort. The patient's report of improved comfort and
function is a positive indicator of effective pain management.
Question 10
Which of the following best describes the role of adjuvant analgesics in pain management?
