Exam (elaborations)
CERTIFIED HOSPICE PALLIATIVE NURSE CHPN EXAM
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CERTIFIED HOSPICE PALLIATIVE NURSE CHPN EXAM
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CERTIFIED HOSPICE PALLIATIVE NURSE CHPN EXAMAIDS infection - Answers -Bacterial, Viral, Fungal, Parasitic
AIDS dementia - Answers -causes Encephalopathy, 15% effected
ALS (amyotrophic lateral sclerosis) 1st symptom - Answers -swallowing difficulty
followed by distal weakness
Cerebral Metastases - Answers -Brain mets account for 40% of all Cancer patients.
Cerebral Metastases symptoms - Answers -HA initial complaint, N/V, confusion,
lethargy
Leukemia 2 types - Answers -chronic and acute
Leukemia Clinical Manifestations - Answers -Infection, fever, enlarged liver, spleen,
kidneys, bleeding/bruising not explained, & hemorrhage
pale, petechia, purpura
liver failure symptoms - Answers -fatigue, jaundice, ascites
Dark urine, gray stool, bruising
symptoms of bleeding internally - Answers -sudden fever > 101°, dyspnea, abdominal
paik, dehydration
Lymphoma types - Answers -Hodgkins and Non-Hodgkins
Hodgkin's disease - Answers -painless lymph node swelling, generally in upper body,
general fatigue, weight loss, fever, nifht sweats, back pain
Non-Hodgkin's Lymphoma - Answers -same symptoms except itching & night sweats
Parkinson's disease - Answers -Slow progression of motor skills, resting tremors,
slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - Answers -pill rolling movements in bands, loss of facial
expression, difficulty initiating movement, gait changes
Renal Cancer/symptoms - Answers -asymptomatic 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 - Answers -pallor, jaundice, weakness, fatigue common symptoms
,sickle cell crisis - Answers -multiple pain events, pale lips, tongje, palms, nail beds,
lethargy, difficulty arousing, high fever 2 days
sickle cell risk - Answers -high r/o bacterial infections
palliative sedation - Answers -midazolam, propofol
terminal weaning - Answers -gradual withdrawal of mechanical ventilation
terminal Extubation - Answers -abrupt Removal of endotracheal tube
Hindus and Buddhists EOL - Answers -get cremated
Embalming - Answers -outside of US/Canada its typically not practiced. no health or
safety reason for it. if burial is delayed the body must be refrigerated. no state requires it
if pt is forgetting pain pills - Answers -switch to a fentanyl patch
CHEOPS (children's Eastern ontario pain scale) - Answers -used for kids 1-7 & based
on 6 characteristics (crying, facial expression, verbalization, torso, upper extremities,
lower extremeties).
CHEOPs scores - Answers -0-2: except for crying 0-3
>4 indicates pain
FACES pain scale - Answers ->7 years. CRIES
C= Assess crying,
R=requirement for O2 or O2 < 95%,
I= Increased vitals (BP, HR), E= expression
S= sleep
Ondansetron (Zofran) - Answers -Indicated for Chemo- abdominal radiation induced
N/V in both geriatric/peds
dexamethasone may be given concurrently to potentiate effects
Haldol (haloperidol) - Answers -indiciated for opiod induce nausea as well as
chemical/mechanical induced nausea but can cause dyskinsea (uncontrollable muscle
movement).
Scopolamine (Transderm Scop) - Answers -Indicated for N/V associated with GI
obstruction, peritoneal irritation, increased IP.
Dronabinol (Marinol) - Answers -used as a second line amtimetic, more effective in
young adults
, Death Rattle Meds - Answers -anticholinergic should be given @ 1st site of moisture.
they cannot dry up secretions already present
poverty barriers at EOL - Answers -additional challenges to EOL care. lack of support.
BIPAP (non-invasive ventilation) - Answers -may 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 - Answers -signs: 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 - Answers -tx neuropathic pain. High A/E
tricyclic antidepressants A/E - Answers -Anticholinergic 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 - Answers -jerks, 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 - Answers -urgent & serious late stage malignancy (unrelated to bone
mets). no tx results in death
hypercalcemia occurrence - Answers -most common breast CA & multiple myeloma but
can occur with others.
Hypercalcemia symptoms - Answers -n/v, constipation, anorexia
weakness, mental change, fatigue
bradycardia, EKG changes
Hypercalcemia treatment - Answers -palliative 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 - Answers -family 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 - Answers -pasty, thick saliva
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