CHPLN MCQs
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A 73-year-old patient with spinal metastases reports severe back pain and difficulty standing. The patient???s serum creatinine is 1.8 mg/dL, and the provider orders ibuprofen 600 mg every 6 hours. What should the LPN do?
Administer the ibuprofen as ordered
Suggest a topical lidocaine patch
Request a renal function reassessment
Use a heating pad on the back
Answer: C
Explanation: Ibuprofen is contraindicated in patients with renal impairment (creatinine 1.8 mg/dL) due to the risk of further kidney damage. Requesting a renal function reassessment ensures safe medication use. Administering ibuprofen risks worsening renal function. A lidocaine patch or heating pad may provide pain relief but does not address the safety concern of ibuprofen in renal impairment.
A hospice team needs to document detailed outcomes for a quality improvement initiative aimed at reducing unnecessary hospitalizations. Which data point is most relevant for reporting?
Satisfaction with meal delivery
Number of completed antibiotic prescriptions
30-day readmission rate
Family???s preferred funeral home
Answer: C
Explanation: The 30-day readmission rate specifically captures hospital utilization, which is the QI project aim. The other data do not reflect hospitalization outcomes.
A 73-year-old patient with heart failure and pulmonary edema has SpO2 87% and BP 150/92 mmHg. Serum BNP is 1,800 pg/mL. Which intervention should the nurse implement first?
Position the patient in a semi-Fowler???s position
Apply BiPAP at 10/5 cm H2O
Increase oxygen to 6 L/min via high-flow cannula
Administer furosemide 40 mg IV over 5 minutes
Answer: A
Explanation: Pulmonary edema with elevated BNP (1,800 pg/mL) requires immediate positioning in a semi-Fowler???s position to reduce preload and improve breathing. This is a quick, non-invasive action. Administer furosemide 40 mg IV over 5 minutes is effective but requires an order. Apply BiPAP at 10/5 cm H2O is invasive and requires setup. Increase oxygen to 6 L/min via high-flow cannula may help but is not the first priority.
A 73-year-old hospice patient with ovarian cancer reports abdominal pain rated 7/10, described as cramping and associated with nausea. The patient is on ondansetron 8 mg PO q8h and morphine 10 mg PO q4h. Labs show a serum albumin of 2.8 g/dL (normal: 3.5???5.0 g/dL). What is the most appropriate next step?
Start hyoscyamine 0.125 mg PO q6h
Increase morphine to 15 mg PO q4h
Add metoclopramide 10 mg PO q6h
Switch to fentanyl 25 mcg/hr q72h
Answer: C
Explanation: The cramping abdominal pain and nausea suggest gastrointestinal dysmotility, common in ovarian cancer with hypoalbuminemia indicating possible ascites or bowel involvement. Metoclopramide, a prokinetic, addresses nausea and cramping. Increasing morphine may worsen nausea. Hyoscyamine is less effective for nausea. Fentanyl is not indicated without renal or hepatic concerns.
A 64-year-old patient with cirrhosis and hepatic encephalopathy has a serum ammonia of 110 ??mol/L and is lethargic. Lactulose 30 mL TID results in 1???2 soft stools daily. Labs: Na+ 128 mEq/L, K+ 3.1 mEq/L. What adjustment should be made to optimize encephalopathy management?
Add polyethylene glycol 17 g daily to increase bowel movements
Start rifaximin 550 mg BID
Increase lactulose to achieve 3???4 stools daily
Supplement potassium to normalize K+ levels
Answer: B
Explanation: Persistent encephalopathy with high ammonia despite lactulose suggests inadequate control. Start rifaximin 550 mg BID is the best option to further reduce ammonia production. Add polyethylene glycol 17 g daily is not standard for HE. Increase lactulose to achieve 3???4 stools daily risks dehydration, given low Na+ and K+. Supplement potassium to normalize K+ levels addresses hypokalemia but not encephalopathy directly.
A 66-year-old patient with liver failure has ascites and a serum albumin of 2.8 g/dL. The family requests home delivery of a hospital bed to improve comfort. What is the LPN???s best action to coordinate care?
Request a dietary consult to increase albumin levels
Contact the physician to discuss paracentesis for ascites
Instruct the family to elevate the patient???s legs to reduce ascites
Arrange for hospital bed delivery through the hospice supplier
Answer: D
Explanation: Arranging for hospital bed delivery through the hospice supplier directly addresses the family???s request to improve patient comfort, aligning with coordination of equipment needs. Contacting the physician for paracentesis addresses ascites but not the immediate comfort request. Instructing leg elevation is ineffective for ascites management. Requesting a dietary consult is unlikely to significantly improve serum albumin (2.8 g/dL) in end-stage liver failure.
A patient with metastatic breast cancer and spinal lesions complains of ???band-like??? chest pain and numbness below the nipple line. Which is the most concerning sign on neurological examination?
Brisk patellar reflexes
Diminished rectal tone
Positive Babinski reflexes
Weak handgrip
Answer: B
Explanation: Loss of rectal tone suggests spinal cord compression with loss of sphincter control, which is an emergency.
A 45-year-old patient with terminal pancreatic cancer expresses regret over not spending more time with their children due to work commitments. The patient is visibly emotional and asks how to cope with these feelings before passing. As a licensed nurse, what is the most therapeutic approach to encourage life review and address their grief?
Encourage the patient to focus on positive memories and avoid dwelling on regrets
Guide the patient to write letters to their children expressing their feelings and memories
Facilitate a family meeting to discuss the patient???s regrets and seek forgiveness
Suggest distraction techniques like watching movies to reduce emotional distress
Answer: B
Explanation: Guide the patient to write letters to their children expressing their feelings and memories is the most therapeutic approach, as it facilitates a structured life review, allowing the patient to process regrets and leave a legacy. This aligns with hospice care???s focus on emotional closure. Encourage the patient to focus on positive memories and avoid dwelling on regrets may minimize the patient???s feelings, while Facilitate a family meeting to discuss the patient???s regrets and seek forgiveness could be overwhelming without prior emotional preparation. Suggest distraction techniques like watching movies to reduce emotional distress avoids addressing the grief directly, which is not therapeutic in this context.
A 66-year-old hospice patient with a diagnosis of end-stage CHF is experiencing shortness of breath despite being on maximum diuretic therapy. Her potassium level is 6.0mEq/L. Which of the following interventions should be the initial focus of your teaching with the family?
Administering an increased dose of potassium chloride supplement
Arranging for a home oxygen cylinder setup and nasal cannula use
Increasing fluid intake to counteract dehydration
Recognizing early signs of hyperkalemia and contacting the hospice nurse immediately
Answer: D
Explanation: Recognizing early signs of hyperkalemia and contacting the hospice nurse immediately is critical due to the elevated potassium (6.0mEq/L, normal 3.5???5.0mEq/L), which may cause life- threatening arrhythmias. Administering more potassium chloride supplement would worsen hyperkalemia. Home oxygen (oxygen therapy) might relieve dyspnea but does not address the potassium imbalance, and increasing fluids could worsen CHF symptoms.
A patient with refractory ascites undergoes paracentesis. Ascitic fluid analysis shows albumin 1.0g/dL and serum albumin 2.6g/dL. What does the serum-ascites albumin gradient (SAAG) indicate?
Cardiac ascites
Malignant ascites
Portal hypertension
Pancreatic ascites
Answer: C
Explanation: SAAG = serum albumin - ascites albumin = 2.6 - 1.0 = 1.6g/dL. A SAAG ???1.1g/dL is
diagnostic for portal hypertension. Cardiac ascites also shows high protein content; malignant and pancreatic ascites show SAAG <1.1g/dL.
A COPD patient in hospice presents with persistent cough, thick secretions, and congestion. Sputum cultures show heavy growth of Pseudomonas aeruginosa. Which inhaled therapy can reduce mucus viscosity and productive cough?
Levalbuterol
Inhaled corticosteroids
Hypertonic saline
Tiotropium
Answer: C
Explanation: Hypertonic saline inhalation increases water content in mucus, reducing viscosity and making expectoration easier. Inhaled corticosteroids (inhaled corticosteroids), levalbuterol (levalbuterol), and tiotropium (tiotropium) do not directly affect sputum viscosity.
A 72-year-old hospice patient with a UTI is prescribed nitrofurantoin 100 mg twice daily. The patient???s creatinine clearance is 20 mL/min. What should the LPN do?
Hold the dose and notify the provider
Administer the medication as ordered
Monitor for pulmonary toxicity
Request a repeat urinalysis in 48 hours
Answer: A
Explanation: Nitrofurantoin is contraindicated in patients with creatinine clearance <30 mL/min due to the risk of toxicity and reduced efficacy. Holding the dose and notifying the provider is the safest action. Administering the medication risks harm. Monitoring for pulmonary toxicity is relevant but secondary to stopping the drug. A repeat urinalysis does not address the immediate safety concern.
A complex care meeting is held to adjust medication for opioid-induced constipation. The nurse notes the patient is on morphine 100mg/24h, with 4 days since the last BM, abdominal distension, and a K+ of 2.8mEq/L. What is the key collaborative action?
Order fleet enema immediately
Inform provider for lab review and patient assessment
Prescribe bisacodyl suppository without consulting the team
Encourage fluid intake only
Answer: B
Explanation: Significant hypokalemia (K+ of 2.8mEq/L, abdominal symptoms) warrants prompt provider notification (Inform provider for lab review and patient assessment). A fleet enema or bisacodyl may not be safe without assessment; more fluids alone (Encourage fluid intake only) is grossly insufficient.
A patient complains of frequent watery stools and fecal incontinence after receiving broad-spectrum antibiotics. What lab value should be prioritized to help guide further treatment?
Stool sodium
Serum amylase
Serum potassium
Stool leukocyte count
Answer: D
Explanation: Stool leukocyte count is useful for diagnosing infectious/inflammatory diarrhea, especially post-antibiotic use (which raises concern for C. difficile). Stool sodium and serum amylase are not directly instructive, while serum potassium is monitored but not diagnostic.
A 61-year-old patient with multiple sclerosis experiences severe paresthesia in the hands, rated 7/10. The patient is on pregabalin 150 mg twice daily, with a recent serum creatinine of 1.9 mg/dL (normal: 0.6???
1.2 mg/dL). What is the most appropriate intervention?
Add duloxetine 30 mg daily
Consult to adjust pregabalin dose due to renal impairment
Initiate amitriptyline 25 mg at bedtime
Start lidocaine 5% topical patch
Answer: B
Explanation: Pregabalin is renally excreted, and the elevated creatinine suggests impaired clearance, potentially causing toxicity. Consulting to adjust the dose is the most appropriate step. Adding duloxetine or amitriptyline increases the risk of side effects in renal impairment. Lidocaine patches are less effective for diffuse paresthesia in this context.
A 69-year-old hospice patient with liver failure and encephalopathy has ammonia 95 ??mol/L. Lactulose 30 mL TID produces 3 stools/day. Labs: Na+ 129 mEq/L, K+ 3.2 mEq/L. What is the most appropriate next step?
Add rifaximin 550 mg BID
Discontinue lactulose and start neomycin
Increase lactulose to 45 mL TID
Start branched-chain amino acids 4 g TID
Answer: A
Explanation: Persistent encephalopathy despite adequate lactulose dosing requires Add rifaximin 550 mg BID to reduce ammonia production. Discontinue lactulose and start neomycin is risky due to toxicity. Increase lactulose to 45 mL TID risks dehydration. Start branched-chain amino acids 4 g TID is experimental and not standard.
An LPN, acting as a preceptor, observes a colleague failing to maintain boundaries by sharing personal family struggles with a patient???s spouse. What is the LPN???s most appropriate response?
Discuss the importance of professional boundaries privately
Encourage the colleague to continue sharing to build rapport
Report the incident to the unit manager immediately
Suggest the colleague attend a patient-family communication course
Answer: A
Explanation: Discuss the importance of professional boundaries privately is the most appropriate, as it corrects the behavior directly and supports professional development. Encourage the colleague to continue sharing risks further boundary violations. Report the incident to the unit manager is premature. Suggest the colleague attend a communication course is less immediate than direct discussion.
A 59-year-old patient with ALS exhibits severe myoclonus, disrupting sleep and causing distress. The patient is on clonazepam 0.5 mg at bedtime, with a recent serum sodium of 132 mEq/L (normal: 135??? 145 mEq/L). What is the most appropriate intervention?
Administer levetiracetam 500 mg twice daily
Start baclofen 10 mg three times daily
Initiate fluid restriction for hyponatremia
Increase clonazepam to 1 mg at bedtime
Answer: D
Explanation: Increasing clonazepam to 1 mg at bedtime is appropriate to control myoclonus, as it is effective and already prescribed. Adding levetiracetam or baclofen introduces new medications unnecessarily. Fluid restriction addresses hyponatremia but not myoclonus, the primary concern.
An LPN/LVN is caring for a patient with a sodium level of 128 mEq/L due to SIADH in hospice care. According to HIPAA, what is the correct procedure for sharing lab results with the patient???s authorized caregiver?
Fax the results to the caregiver???s office
Text the results to the caregiver???s phone
Share results verbally in a public area
Provide a printed copy in a sealed envelope
Answer: D
Explanation: HIPAA requires secure transmission of protected health information, such as a sodium level of 128 mEq/L, by providing a printed copy in a sealed envelope to the authorized caregiver. Fax the results to the caregiver???s office risks interception. Share results verbally in a public area violates privacy. Text the results to the caregiver???s phone is not secure.
A 69-year-old patient with terminal lung cancer has a PCO2 of 50 mmHg and reports drowsiness. The family is concerned about the patient???s ability to communicate. What is the LPN???s best action to facilitate communication?
Facilitate a family meeting with the interdisciplinary team
Arrange for a speech therapist to assess communication
Administer oxygen at 3 L/min to improve alertness
Instruct the family to use written communication
Answer: A
Explanation: Facilitating a family meeting with the interdisciplinary team addresses the family???s concerns about communication and the patient???s drowsiness (PCO2 50 mmHg), ensuring collaborative discussion of care options. Administering oxygen requires a physician???s order and may not address drowsiness. Arranging a speech therapist is inappropriate for drowsiness-related issues. Using written communication does not address the underlying cause or family concerns.
A hospice patient???s family is experiencing anticipatory grief. Which finding most commonly
distinguishes anticipatory grief from pathological grief?
Complete loss of function and persistent suicidal ideation
Hopefulness for resolution and some positive emotions
Psychotic symptoms
Total withdrawal from social interaction
Answer: B
Explanation: Anticipatory grief often features periods of hope or positive feeling alongside sadness and loss. Pathological grief includes functional loss, suicidality, psychosis, or persistent social withdrawal.
A 62-year-old patient with advanced dementia is admitted to hospice with a PPS score of 30%. The patient is nonverbal, bedbound, and has a recent history of aspiration pneumonia. The family reports increased agitation and grimacing during repositioning. Which intervention best addresses the patient???s symptoms and disease trajectory?
Start artificial nutrition via a nasogastric tube to improve strength
Initiate a trial of lorazepam 0.5 mg PO every 6 hours for anxiety
Order a chest X-ray to evaluate for recurrent aspiration pneumonia
Administer haloperidol 0.5 mg IM every 4 hours as needed for agitation
Answer: D
Explanation: In advanced dementia with a PPS of 30%, agitation and grimacing are likely due to pain or discomfort, and haloperidol 0.5 mg IM every 4 hours as needed is appropriate for managing agitation in this context. Initiating a trial of lorazepam 0.5 mg PO every 6 hours for anxiety is less appropriate, as benzodiazepines can worsen confusion in dementia patients. Ordering a chest X-ray to evaluate for recurrent aspiration pneumonia is not aligned with hospice goals, as it does not address comfort. Starting artificial nutrition via a nasogastric tube to improve strength is contraindicated, as it increases aspiration risk and does not improve outcomes in end-stage dementia.
A 70-year-old hospice patient with multiple myeloma reports a new onset of hip pain after a minor fall. X-ray confirms a femoral neck fracture. The patient???s hemoglobin is 9.8 g/dL. What is the most appropriate nursing action?
Administer morphine 5 mg IV every 4 hours
Immobilize the hip with a pillow
Encourage ambulation with a walker
Apply a traction splint to the affected leg
Answer: B
Explanation: A femoral neck fracture in a hospice patient with multiple myeloma requires immobilization to reduce pain and prevent further injury. Using a pillow to immobilize the hip is a non-invasive, appropriate action for comfort-focused care. Morphine may be needed but requires a provider order. A traction splint is invasive and not suitable for hospice care. Ambulation is contraindicated due to the fracture and anemia (hemoglobin 9.8 g/dL).
An LPN is reading a journal article about self-care strategies for hospice nurses. A patient???s recent death has left the LPN feeling emotionally drained. Which self-care intervention should the LPN prioritize?
Engage in high-intensity exercise to release stress
Work additional shifts to stay distracted
Take a temporary leave of absence from work
Participate in a peer support group for hospice nurses
Answer: D
Explanation: Participate in a peer support group for hospice nurses is the most appropriate, as it provides emotional support and shared experiences to address grief. Engage in high-intensity exercise may help but doesn???t address emotional needs directly. Take a temporary leave of absence is extreme and avoids processing emotions. Work additional shifts exacerbates burnout.
A hospice patient with severe mitral regurgitation and orthopnea has NT-proBNP of 3,680pg/mL. ABG: pH 7.35, PaCO2 43mmHg, PaO2 60mmHg. What parameter indicates successful management of pulmonary edema?
Increased serum sodium
Reduction of jugular venous distention
Stable platelet count
WBC improvement
Answer: B
Explanation: Reduction in jugular venous distention reflects successful reduction of venous pressure and pulmonary congestion. Serum sodium, platelet count, and WBC are unrelated.
A 72-year-old patient with end-stage renal disease is on hospice care at home. The family reports difficulty affording the patient's medications due to limited income and lack of insurance coverage. The
patient???s monthly income is $1,200, and medication costs exceed $400 monthly. What is the most appropriate action for the hospice nurse to take to address this socioeconomic barrier?
Contact a local pharmacy to negotiate a discount on medications
Tell the family to prioritize essential medications and skip non-essential ones
Suggest the family reduce the frequency of medication doses to cut costs
Refer the family to a social worker for assistance with financial aid programs
Answer: D
Explanation: Refer the family to a social worker for assistance with financial aid programs is the most appropriate action, as it addresses the socioeconomic barrier by connecting the family with resources like Medicaid, pharmaceutical assistance programs, or hospice foundation grants, which can cover medication costs without compromising care. Contact a local pharmacy to negotiate a discount may help but is less comprehensive and not always feasible. Suggest the family reduce the frequency of medication doses or prioritize essential medications risks patient safety and violates hospice care standards, as it could lead to inadequate symptom management.
A 63-year-old hospice patient with lung cancer reports chest pain rated 6/10, described as sharp and worse with inspiration. The patient is on morphine 5 mg PO q4h. Labs show a D-dimer of 2.5 ??g/mL (normal: <0.5 ??g/mL). What is the most likely cause of the pain?
Costochondritis
Pericarditis
Pleuritic pain
Tumor invasion
Answer: C
Explanation: The sharp, inspiratory pain and elevated D-dimer suggest pleuritic pain, likely from a pulmonary embolism or pleural involvement in lung cancer. Costochondritis is movement-related. Pericarditis causes pain relieved by sitting forward. Tumor invasion is less likely without constant pain.
A 64-year-old patient with end-stage renal disease has a stage II pressure ulcer on the heel, with a 2 cm x 2 cm shallow crater and minimal exudate. The patient???s serum albumin is 3.0 g/dL. Which dressing is most appropriate?
Hydrogel dressing, changed daily
Alginate dressing, changed every 2 days
Silver-impregnated foam, changed every 3 days
Transparent film dressing, changed every 5???7 days
Answer: A
Explanation: A hydrogel dressing, changed daily, is appropriate for a stage II pressure ulcer with minimal exudate, as it maintains a moist environment to promote healing in a patient with low albumin (3.0 g/dL). Alginate is better for high-exudate wounds (Alginate dressing, changed every 2 days). Silver- impregnated foam is used for infected wounds, not indicated here (Silver-impregnated foam, changed every 3 days). Transparent film is unsuitable for open craters (Transparent film dressing, changed every 5???7 days).
A patient with terminal liver disease and coagulopathy (INR 2.6, platelets 35,000) develops constant, severe right flank pain unrelieved by acetaminophen. What is the most appropriate next pharmacological intervention?
Morphine
High-dose NSAIDs
Fentanyl patch
Regional nerve block
Answer: C
Explanation: Fentanyl is effective, with less risk of metabolite accumulation in liver dysfunction than morphine. NSAIDs are contraindicated due to bleeding risk. Regional nerve block might be risky due to coagulopathy. Morphine may accumulate, worsening sedation/toxicity.
An LPN is developing a self-care plan after a patient???s death triggers unresolved grief. Which intervention is most appropriate for emotional processing?
Take a short-term leave to avoid triggers
Increase clinical workload to stay distracted
Attend a grief counseling session with a professional
Write a letter to the patient???s family
Answer: C
Explanation: Attend a grief counseling session with a professional is the most appropriate, as it provides structured support for processing grief. Increase clinical workload exacerbates emotional strain. Take a short-term leave avoids processing grief. Write a letter to the patient???s family risks boundary violations.
A patient with end-stage heart failure has a BNP of 1,200 pg/mL and reports severe fatigue. The nurse is teaching about symptom relief. Which intervention should the nurse prioritize?
Administer furosemide 40 mg IV as prescribed to reduce fluid overload
Encourage high-intensity exercise to improve cardiac output
Increase dietary sodium to stabilize electrolyte levels
Use a fan to blow air across the face for comfort
Answer: A
Explanation: Elevated BNP (1,200 pg/mL, normal <100 pg/mL) indicates fluid overload in heart failure. Administering furosemide as prescribed reduces fluid, alleviating fatigue and dyspnea. High-intensity exercise is contraindicated, increasing sodium worsens fluid retention, and a fan is less effective for fatigue.
A home hospice nurse finds that the patient???s home has loose scatter rugs, dim lighting and extension cords across walkways. What standardized tool should the nurse use to document fall risk?
Braden Scale
Glasgow Coma Scale
Morse Fall Scale
Barthel Index
Answer: C
Explanation: The Morse Fall Scale is validated for assessing fall risk based on home hazards, while the other options assess different domains.
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