Mixed Deck — All ACHPN Topics Flashcards

Which of the following documentation practices BEST supports continuity of care across the palliative care IDT?

Answer: A shared, integrated care plan updated after each IDT meeting and accessible to all team members

A shared, integrated care plan accessible to all disciplines ensures consistent care delivery and prevents miscommunication across the team.

A hospice caregiver reports she has not slept more than 3 hours nightly for two weeks. Which action should the ACHPN take first?

Answer: Assess for respite care needs and connect with the interdisciplinary team

Caregiver sleep deprivation is a sign of significant burden; the ACHPN should assess the need for respite care and mobilize the interdisciplinary team to provide relief and support.

An unresponsive patient in the final days of life develops a fever of 38.9°C (102°F). The patient does not appear distressed. The family asks if something should be done. Which of the following statements represents the most appropriate approach to managing fever in this context?

Answer: The primary goal is to treat the fever only if it is causing distress to the patient, often with acetaminophen administered rectally.

In the imminently dying patient, the goal of care shifts entirely to comfort. Fever should be treated only if it is perceived to be a source of discomfort for the patient (e.g., causing restlessness or sweating). Aggressive interventions like antibiotics are inconsistent with comfort-focused goals. Gentle non-pharmacologic measures (e.g., light clothing) are preferred over aggressive cooling methods, which can cause shivering and discomfort. Acetaminophen suppositories are a common and effective pharmacologic approach when treatment is indicated for comfort.

When assessing a patient's decision-making capacity in palliative care, which four elements must be established?

Answer: Understanding, appreciation, reasoning, and ability to communicate a choice

Decision-making capacity requires that the patient demonstrate understanding, appreciation, reasoning, and the ability to communicate a consistent choice.

When facilitating an IDT care conference for a patient with advanced dementia, which framework is most useful for guiding goals-of-care discussions?

Answer: Substituted judgment and best interest standards using family as surrogate decision-makers

When a patient lacks decision-making capacity, substituted judgment and best interest standards guide surrogates to make decisions aligned with the patient's values.

Which palliative care assessment framework uses the acronym 'IPOS' to capture patient-reported outcomes?

Answer: Integrated Palliative Outcome Scale

The IPOS (Integrated Palliative Outcome Scale) is a validated patient-reported outcome measure that captures physical symptoms, psychological concerns, and family/information needs in palliative care.

A nurse on the palliative care team is experiencing moral distress related to a patient receiving aggressive treatment against their previously stated wishes. Which is the MOST appropriate first step?

Answer: Raise the concern through the appropriate institutional channels, such as an ethics consultation or team debriefing

Moral distress should be addressed through proper channels such as ethics consultation or team debriefing, which protects the nurse, patient, and team dynamics.

A patient with AIDS has a CD4+ count of 24, a viral load of 110,000, and a 35% drop in lean body mass. The Karnofsky Performance Scale score needed to qualify the patient for hospice care is:

Answer: <50.

Explanation: If a patient with AIDS has a CD4+ count of 24, a viral load of 110,000, and a 35% drop in weight, the Karnofsky Performance Scale score needed to qualify the patient for hospice care is less than 50, which indicates that the patient is in need of assistance with activities of daily living and requires frequent medical care. The KPS classifies patients according to their functional ability, and a low score indicates a low chance of survival.

When assessing a palliative patient for depression, which factor complicates using standard DSM criteria?

Answer: Somatic symptoms of depression overlap with symptoms of serious illness

Somatic symptoms such as fatigue, anorexia, and sleep disturbance overlap between depression and serious illness, making standard DSM criteria less reliable in palliative assessment.

The palliative care IDT is conducting a quality improvement review of care transitions. Which metric is MOST relevant to assess?

Answer: Rate of unplanned emergency department visits within 72 hours of hospice enrollment

Unplanned ED visits within 72 hours of hospice enrollment indicate care transition failures and are a key quality metric in palliative and hospice care.

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?

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

The BODE index (Body-mass index, airflow Obstruction, Dyspnea, and Exercise capacity) is a validated prognostic tool for COPD. A score of 7-10 places a patient in the highest risk quartile, which is associated with high mortality. A score of 9 specifically correlates with an approximate 80% mortality rate at 52 months (roughly 4 years), meaning about a 20% survival rate. This poor prognosis supports a focus on palliative care rather than aggressive, curative therapies.

Which intervention by the ACHPN best supports a family caregiver who insists on continuing curative treatment against the palliative care team's recommendation?

Answer: Explore the family's fears and hopes underlying their request using empathic communication

Empathic exploration of the family's underlying fears and hopes often reveals unaddressed concerns that, once acknowledged, can facilitate a more informed and aligned decision.

Which of the following interventional techniques is most appropriate for managing intractable abdominal pain secondary to a celiac plexus tumor in a patient with a life-limiting illness?

Answer: Celiac plexus block

A celiac plexus block is an injection procedure used to block the nerves that serve the abdominal organs, making it a targeted and effective treatment for pain originating from conditions like pancreatic cancer or other abdominal malignancies involving the celiac plexus. Vertebroplasty is for vertebral compression fractures. A spinal cord stimulator is typically used for chronic neuropathic pain of the trunk or limbs. Trigger point injections are for myofascial pain.

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?

Answer: The adult children together, seeking consensus.

In the absence of a designated healthcare agent, most states have a legally specified hierarchy for surrogate decision-making. After a spouse, adult children typically have equal standing. The clinical team's primary obligation is to work with both children to reach a consensus based on the principle of substituted judgment—what the patient would have wanted. An ethics committee consultation is appropriate to facilitate mediation and clarify ethical principles, but the committee does not become the decision-maker. Prioritizing one child's view over the other's is not legally or ethically appropriate.

When assessing a hospice patient for constipation, which piece of information is most crucial for the advanced practice nurse to obtain first?

Answer: The patient's usual and current bowel pattern.

Constipation is defined relative to the individual's normal pattern. Therefore, the most critical initial step is to establish the patient's baseline or usual bowel habit and compare it to their current pattern. This subjective information is key because what constitutes constipation varies significantly from person to person.

A palliative patient newly reports difficulty swallowing medications. Which assessment should the ACHPN prioritize?

Answer: Swallowing function and ability to use alternative medication routes

New dysphagia in a palliative patient requires assessment of swallowing function and identification of alternative routes (sublingual, subcutaneous, rectal) for essential medications.

If a patient with chronic bowel disease has developed persistent diarrhea, the treatment most indicated to control the diarrhea is:

Answer: loperamide.

Explanation: If a patient with chronic bowel disease has developed persistent diarrhea, the treatment most indicated to control the diarrhea is loperamide, which is indicated for nonspecific diarrhea but should be avoided if the patient has grossly bloody stool or temperature above 38° C (101° F) or if infection with C. difficile or Shigella is suspected. Loperamide is usually given at 4 mg initially followed by 2 mg after each loose stool to a total of 16 mg per day.

An obese patient with diabetes mellitus who underwent surgery for bowel obstruction 6 days previously and has had persistent abdominal distention and episodes of nausea and vomiting indicates a desire for palliative care. The patient complains of feeling a "popping" sensation at the incision site, and the advanced practice registered nurse notes a large amount of serosanguinous drainage on the dressing and separation at the center of the incision line with beginning intestinal evisceration. The initial response should be to:

Answer: place the patient in a semi-Fowler's position with knees elevated and notify the surgeon.

Explanation: If a patient who has indicates a desire for palliative care complains of feeling a "popping" sensation at an abdominal incision site, and the advanced practice registered nurse notes a large amount of serosanguinous drainage on the dressing and separation at the center of the incision line with beginning intestinal evisceration, the initial response should be to place the patient in semi-Fowler's position, notify the surgeon, cover the wound with sterile saline-soaked gauze, start an IV line, and administer oxygen. Palliative care does not preclude responding to emergent changes in condition.

An ACHPN is preparing to inform a 55-year-old patient with metastatic lung cancer that recent scans show significant disease progression. According to the SPIKES protocol for delivering difficult news, which of the following actions should the ACHPN take first after establishing a private and comfortable setting?

Answer: Assess the patient's perception by asking, "What is your understanding of why we did these scans?"

The SPIKES protocol is a six-step framework for delivering bad news: S-Setting, P-Perception, I-Invitation, K-Knowledge, E-Emotions, S-Strategy/Summary. After establishing the setting (S), the next crucial step is to assess the patient's Perception (P) of their situation. Asking what they already understand allows the nurse to correct misinformation and tailor the delivery of new information to the patient's current level of comprehension.

An ACHPN is caring for a patient with metastatic cancer who states, "I used to be so religious, but now I feel like God has abandoned me. I don't see the point in anything anymore." The patient is tearful and withdrawn but denies suicidal ideation. This presentation is most characteristic of:

Answer: Spiritual distress.

The patient's statements of feeling abandoned by God and questioning their previously held beliefs are hallmark features of spiritual distress. While these feelings can overlap with depression or grief, the core issue described is a crisis of faith and meaning. [22, 27] The APN's role is to recognize this and engage appropriate resources, like a chaplain, while also continuing to screen for depression.