ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Prognostication and Disease Trajectories Questions and Answers

Question 1

An 84-year-old male with NYHA Class IV heart failure has been hospitalized three times in the past four months for exacerbations.
He is optimally treated with diuretics and vasodilators but remains symptomatic at rest.
Which of the following is the strongest clinical indicator supporting a hospice-appropriate prognosis?

Accepted Answer

Persistent dyspnea and fatigue at rest

Answer

Ejection fraction of 35%

Answer

Serum sodium of 137 mEq/L

Answer

Presence of +1 pedal edema

Question 2

Which of the following disease trajectories is most commonly associated with advanced organ failure, such as end-stage COPD or congestive heart failure?

Accepted Answer

A long-term limitation with intermittent, serious, and life-threatening exacerbations

Answer

A short period of evident decline following a high baseline of function

Answer

A prolonged, dwindling course of progressive disability over many years

Answer

A sudden, unexpected death with no prior identifiable warning signs

Question 3

An ACHPN is using the Functional Assessment Staging Tool (FAST) to evaluate a patient with advanced Alzheimer's disease. The patient has recently lost the ability to speak more than five or six intelligible words per day. According to the FAST scale, this finding places the patient in which stage, which is a key marker for a life expectancy of six months or less?

Accepted Answer

Stage 7a

Answer

Stage 6e

Answer

Stage 7c

Answer

Stage 6d

Question 4

The Palliative Performance Scale (PPS) is a widely used tool for prognostication. A patient who spends the majority of their day sitting or lying down, has extensive disease, and requires considerable assistance with most personal care would most likely be assigned which PPS level?

Accepted Answer

50%

Answer

70%

Answer

30%

Answer

90%

Question 5

An ACHPN is evaluating an 88-year-old patient with metastatic lung cancer who has been declining rapidly. Which of the following clinical signs is the most reliable predictor of a prognosis of weeks to a few months?

Accepted Answer

A Karnofsky Performance Status (KPS) score of 30%

Answer

New onset of confusion

Answer

Decreased appetite and oral intake

Answer

Increased sleepiness and withdrawal

Question 6

A 75-year-old patient with severe COPD has a BODE index score of 9. The ACHPN recognizes that this score indicates which of the following regarding the patient's prognosis?

Accepted Answer

A high risk of mortality, with an approximate 4-year survival rate of only 20%

Answer

Mild disease with a favorable long-term prognosis

Answer

An immediate need for lung transplantation evaluation

Answer

A strong indication for aggressive, curative-intent therapies