ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Ethical and Legal Considerations Questions and Answers

Question 1

An 88-year-old patient with end-stage heart failure is admitted with pneumonia.
He has no advance directive and has lost decisional capacity.
His two adult children are in conflict: his son wants to pursue aggressive treatment, including intubation, while his daughter states the patient would have wanted comfort-focused care only.
The patient's wife is deceased.
According to the most common legal hierarchy for surrogate decision-making, who should the clinical team primarily consult?

Accepted Answer

The adult children together, seeking consensus.

Answer

The son, as he is advocating for life-sustaining treatment.

Answer

The daughter, as she is advocating for comfort care.

Answer

The hospital ethics committee to make the final decision.

Question 2

Which of the following is the primary ethical justification for administering escalating doses of opioids to relieve severe pain in a terminally ill patient, even with the foreseeable, but unintended, consequence of hastening the patient's death?

Accepted Answer

Principle of Double Effect

Answer

Beneficence

Answer

Medical Futility

Answer

Patient Autonomy

Question 3

An ACHPN is assessing the decisional capacity of a patient regarding a palliative chemotherapy regimen. The patient can clearly state their preference to decline the treatment. Which additional element is most critical for the ACHPN to confirm that the patient has decisional capacity?

Accepted Answer

The patient's understanding of the risks, benefits, and alternatives to the proposed treatment.

Answer

The patient's agreement with the physician's recommendation.

Answer

The patient's ability to name a durable power of attorney for health care.

Answer

The absence of a psychiatric diagnosis, such as depression.

Question 4

The primary goal of palliative sedation in the imminently dying patient is to:

Accepted Answer

Relieve intractable and refractory symptoms causing distress.

Answer

Induce a coma to ensure the patient does not awaken.

Answer

Hasten the dying process to end suffering.

Answer

Provide respite for family members overwhelmed by caregiving.

Question 5

Which federal law requires Medicare and Medicaid-participating facilities, including hospices, to inform patients in writing of their right to accept or refuse treatment and their right to formulate an advance directive?

Accepted Answer

Patient Self-Determination Act (PSDA)

Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer

Americans with Disabilities Act (ADA)

Question 6

From an ethical standpoint, the distinction between withholding and withdrawing life-sustaining treatment, such as artificial nutrition and hydration, is that:

Accepted Answer

There is no inherent ethical or legal difference between the two actions.

Answer

Withdrawing treatment is generally considered more ethically problematic than withholding it.

Answer

Withholding treatment requires a higher burden of proof for medical futility.

Answer

Withdrawing treatment is permissible, but withholding artificial nutrition is never ethically acceptable.