ACHPN Palliative Care Assessment and Diagnosis 2 — Questions and Answers
Question 1: Which diagnostic criterion differentiates terminal delirium from dementia in a hospice patient?
- Presence of hallucinations
- Acute onset and fluctuating course (Correct answer)
- Age over 80 years
- Elevated creatinine levels
Correct answer: Acute onset and fluctuating course
Terminal delirium is distinguished from dementia by its acute onset and fluctuating course, whereas dementia involves gradual, progressive cognitive decline.
Question 2: An ACHPN is assessing a patient's prognosis using the Palliative Prognostic Score (PaP). Which variable is included in this tool?
- Blood type
- Karnofsky Performance Status (Correct answer)
- Daily opioid dose
- Patient's religious affiliation
Correct answer: Karnofsky Performance Status
The Palliative Prognostic Score (PaP) includes Karnofsky Performance Status along with clinical symptoms and lab values to estimate survival probability.
Question 3: When assessing a palliative patient for depression, which factor complicates using standard DSM criteria?
- Patients rarely experience depression at end of life
- Somatic symptoms of depression overlap with symptoms of serious illness (Correct answer)
- Depression is not relevant in palliative care
- Antidepressants are contraindicated in hospice
Correct 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.
Question 4: Which tool is specifically validated for assessing pain in cognitively impaired hospice patients who cannot self-report?
- Numeric Rating Scale (NRS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Brief Pain Inventory
- McGill Pain Questionnaire
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
The PAINAD scale is validated for assessing pain in patients with advanced dementia who cannot reliably self-report, using behavioral observations.
Question 5: A hospice patient presents with new urinary retention. Which assessment step should the ACHPN perform first?
- Order an MRI of the spine
- Assess for opioid-induced urinary retention or spinal cord compression (Correct answer)
- Discontinue all current medications
- Refer immediately to urology
Correct answer: Assess for opioid-induced urinary retention or spinal cord compression
New urinary retention in a hospice patient should first prompt assessment for opioid side effects or spinal cord compression, both of which are urgent and treatable.
Question 6: Which lab value trend is most useful in assessing declining renal function in a palliative patient on opioids?
- Hemoglobin A1c
- Serum creatinine (Correct answer)
- Serum albumin
- INR
Correct answer: Serum creatinine
Rising serum creatinine indicates declining renal function, which is critical in palliative patients on opioids because metabolite accumulation can worsen sedation and neurotoxicity.
ACHPN Palliative Care Assessment and Diagnosis 2
Which diagnostic criterion differentiates terminal delirium from dementia in a hospice patient?