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CHPN Exam: Questions & Complete Solutions (100%)
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CHPN Exam: Questions & Complete Solutions (100%)
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CHPN Exam: Questions & Complete Solutions (100%)FAST Scale Right Ans - Used for pt with dementia
1 (no difficulty with ADLs) to 7 (Advanced dementia with limited ability to
speak and perform ADL)
Karnofsky Scale Right Ans - Used to measure health over time
100 (normal, no evidence of disease) to 10 (fatal processes progressing
rapidly) to 0 (dead)
Eastern Cooperative Oncology group assessment Right Ans - 0 (fully active,
no restriction from disease) to 4 (completely disabled) to 5 ( dead)
Palliative care: Right Ans - holistic approach to promoting pt comfort
within limits of disease process. Focus on sx management and can be
incorporated into pt care at any stage of a disease process
Hospice vs Palliative Care Right Ans - Hospice is care for terminally ill and
dying pt. Palliative is for all stages, aimed at promoting comfort for seriously
ill pts. Palliative is provided in conjunction with either curative or EOL tx.
Hospice provides bereavement services up to 1 year after death. Hospice care
is covered by Medicare hospice benefit, palliative care may or may not be
covered. Hospice care life expectancy is 6 months or less.
Hospice qualifications: Right Ans - need to be documented at least Q15
days. PPS <70%
Weeks to months prior to death Right Ans - One of the earliest signs: loss of
appetite leading to marked weight loss and cachexia. Artificial nutrition can be
considered if within pt wishes, but does little good at EOL and may increase
distressing sx (N/V, aspiration, edema, CHF, pulm edema, general fluid
overload). PO fluid intake should be encouraged for as long as possible.
Days to weeks prior to death Right Ans - Pt may experience depression,
anxiety, grief, feelings of isolation and suffering, hopelessness
Pts with dx COPD experience highest level of anxiety, likely r.t episodes of
dyspnea
Progressive physical weakness, dependence on caregivers, dysphasia or
aphasia (complete inability to swallow)
,Kennedy ulcer: EOL PI
Final hours to days Right Ans - Advise family to say goodbye and resolve
conflicts, gather loved ones
Create momentos and finalize funeral arrangements
Common signs of approaching death: confusion, vision of loved ones who have
passed away, terminal agitation, apnea, Cheyne-Stokes respirations, agonal
breathing, terminal secretions, temporal wasting, pain, cyanosis and cooling of
extremities and lips, peripheral edema, mottling, oliguria→ anuria
Priority intervention is educating family. Somnolence, decreased appetite, and
cyanosis do not cause pain or distress to the pt.
Pt may have a "predeath rally": sudden reawakening with coherent
conversations, increased appetite and awareness of surroundings. Return to
semi-comatose state within hours
Cheyne Stokes and Agonal breathing Right Ans - Cheyne stokes: irregular
pattern of fast and shallow breathing followed by periods of apnea
Agonal breathing: labored, gasping breaths
Terminal secretions Right Ans - Terminal secretions are r/t inability to
swallow saliva and clear secretions moving w respirations. Anticholinergics
can be given (ie scopolamine glycopyrrolate atropine hyoscamine)
progression of CA, COPD and CHF, and dementia and debility Right Ans -
Cancer dx typically follows a trajectory of relative wellness for a period of
time followed by a short predictable period of decline
COPD and CHF slow decline with periods of acute exacerbations
Dementia and debility follow a gradual decline over a period of 6-8 years
what is cancer Right Ans - Cancer is a group of diseases characterized by
genetic mutations in normal cells involving oncogenes (mutant genes that
regulate cell proliferation) and inactivated tumor suppressor genes (impede
cell proliferation and suppressed or prevent cell mutations)
what is the greatest risk of CA Right Ans - advancing age
What is the leading cause of CA death Right Ans - The leading cause of
cancer death in US men and women is lung CA. Men: followed by colorectal
and prostate CA, Women: breast and colorectal cancers
,Malignancy: Right Ans - characterized by uncontrolled growth
Metastasis Right Ans - : transference of CA cells from primary site to other
areas of body via bloodstream of lymphatic system
Neoplasm Right Ans - : "new growth" uncontrolled tumor growth
Oncogenesis: Right Ans - transformation of normal, healthy cells into CA
cells
ANgiogenesis: Right Ans - formulation of vessels from the tumor
Tumor staging Right Ans - TNM (tumor, node, metastasis)
Primary tumor (T)
TX: primary tumor cannot be measures
T0: no evidence of tumor
T1-T4: refers to size and extent of the main tumor. The higher the number, the
large the tumor is or the more it has grown into nearby tissues.
Regional lymph node (N)
NX: cancer in nearby lymph nodes cannot be measured
N0: no evidence of CA in nearby lymph nodes
N1-N3: refers to the number and location of lymph nodes that contain cancer.
The higher the number after N, the more lymph nodes that contain CA
Distant Metastasis (M)
MX: mets cannot be measures
M0: no evidence that CA has spread to other parts of the body
M1: there is evidence that CA has spread to other parts of the body
In situ: Right Ans - abnormal cells are present but have not spread to
nearby tissue
localized vs regional vs distant CA Right Ans - Localized: CA cells are
present but have not spread to other parts of the body
Regional: CA has spread to areas near the primary tumor site such as lymph
nodes, tissues, or organs
Distant: CA has spread to area of the body that are not near the primary tumor
site
, Radiation tx Right Ans - Can be delivered externally (teletherapy) or
internally (brachytherapy)
Teletherapy Right Ans - external beams of radiation to tumor from outside
the body
Low-energy radiation: used for topical CA, such as melanoma
High energy radiation: necessary for deeper tumors
Stereotactic radiation: used for tx of brain, head, and neck tumors because it
allows for high-dose radiation to be targeted at a specific body area
Gamma Knife surgery: destroy tumor tissue, requires no incision, does not
harm healthy tissue
Brachytherapy: Right Ans - insertion of radioactive material directly into
the tumor site
Chemotherapy Right Ans - the use of chemical agents to hinder the
replication of malignant cells. Can lead to destruction of rapidly reproducing
healthy cells - cells in the digestive, reproductive tract, hail follicles, bone
marrow. Leads to N/V, diarrhea, neutropenia, thrombocytopenia, alopecia,
anemia. Be aware of sx associated with low WBC, RBC, platelets
Most common sx associated with end-stage CA Right Ans - fatigue, pain,
decreased appetite and dyspnea
Tumor lysis syndrome (TLS): Right Ans - occurs due to rapid breakdown of
tumors and cannot be cleared by kidneys so cell byproducts remain in the
bloodstream. Build up of metabolites resulting in hyperK, hyperPhos,
hyperuricemia (which leads to gout and kidney stones). Can be fatal.
TLS sx, dx, and tx Right Ans - Sx: n/v, diarrhea, weakness/fatigue,
neuralgia, arrhythmia, confusion, hallucinations, restlessness, seizure
Dx: CBC, uric acid levels, UA
Tx: allopurinol to reduce uric acid, IV hydration, diuresis, HD may be required
DIC Right Ans - characterized by excessive blood clotting, leading to muscle
infarctions in vessels and organs, leading to organ damage. Internal bleeding
occurs due to platelet depletion
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