CHPN - Certified Hospice and Palliative Nurse Education, Support, and Advocacy Questions and Answers — Questions and Answers
Question 1: A hospice patient with a valid Physician Orders for Life-Sustaining Treatment (POLST) form indicating "Do Not Hospitalize" develops a fever and urinary symptoms. The patient's distressed adult child demands the patient be sent to the emergency room. What is the CHPN's primary advocacy role in this situation?
- Call 911 immediately to transport the patient as the family requested.
- Tell the family that their request goes against the patient's legal document and cannot be honored.
- Gently reorient the family to the patient's stated wishes on the POLST form and explore their underlying fears. (Correct answer)
- Contact the on-call physician to request an order to override the POLST due to family distress.
Correct answer: Gently reorient the family to the patient's stated wishes on the POLST form and explore their underlying fears.
The nurse's primary role as an advocate is to uphold the patient's documented wishes as stated in the POLST, which is a medical order. This involves therapeutically communicating these wishes to the family, exploring the reasons for their request (which often stem from fear or guilt), and providing education and support to align care with the patient's goals. Simply refusing or immediately calling 911 fails to address the family's emotional needs and the core principles of patient advocacy.
Question 2: When educating a family about the signs and symptoms of the active dying phase, which of the following is MOST important for the CHPN to emphasize to help reduce family distress?
- An exact timeline of when each specific symptom will appear.
- The importance of encouraging the patient to eat and drink to prevent weakness.
- The likelihood that the patient will experience severe, uncontrolled pain at the very end.
- That changes like mottling, altered breathing patterns, and decreased socialization are a normal part of the process. (Correct answer)
Correct answer: That changes like mottling, altered breathing patterns, and decreased socialization are a normal part of the process.
Educating the family that common signs like Cheyne-Stokes respirations, skin mottling, and social withdrawal are expected parts of the dying process can normalize the experience and reduce fear. It reframes these signs as part of a natural process rather than as active suffering. Providing an exact timeline is impossible, forcing fluids is not recommended as needs decrease, and focusing on uncontrolled pain can increase anxiety unnecessarily.
Question 3: The spouse of a hospice patient tearfully states, "I feel like I'm already mourning him, even though he's still here. Is something wrong with me?" Which response by the CHPN best provides therapeutic support?
- "You should try to focus on the positive memories you still have time to make."
- "What you are describing is very common and is known as anticipatory grief. It's okay to talk about these feelings." (Correct answer)
- "It's important that you remain strong for him during this difficult time."
- "These feelings are concerning; perhaps you should speak with a psychiatrist."
Correct answer: "What you are describing is very common and is known as anticipatory grief. It's okay to talk about these feelings."
This response validates the spouse's feelings, normalizes the experience by naming it (anticipatory grief), and invites further discussion. It is a non-judgmental, therapeutic communication technique that opens the door for emotional support. The other options are dismissive, give unhelpful advice, or inappropriately suggest a psychiatric referral for a normal grief reaction.
Question 4: A CHPN is providing education to a family caregiver on the safe management of liquid opioids in the home. Which instruction is a critical component of this education to prevent diversion and ensure safety?
- "Keep a detailed, written log of every dose given, including the date, time, and amount." (Correct answer)
- "Dispose of any small amounts of unused medication by flushing it down the toilet."
- "Store the medication on the kitchen counter so you don't forget a dose."
- "It is acceptable to share the medication with another family member who has severe pain."
Correct answer: "Keep a detailed, written log of every dose given, including the date, time, and amount."
Accurate and consistent documentation of controlled substance administration is a key safety measure to prevent accidental overdose, track symptom response, and identify potential diversion. Best practices for preventing diversion also include using a lockbox and performing regular pill counts, which are facilitated by a detailed log. Medication should be stored securely, not shared, and disposed of according to specific hospice policy and DEA guidelines, which may not involve flushing.
Question 5: Which of the following actions by a CHPN best demonstrates patient advocacy for a non-verbal patient with advanced dementia who has become restless and is fidgeting with their clothes?
- Asking the family what they believe the patient needs.
- Documenting the restlessness and planning to reassess in one hour.
- Performing a full assessment, including checking for pain, repositioning the patient, and ensuring they are clean and dry. (Correct answer)
- Administering the prescribed PRN dose of an anxiolytic medication immediately.
Correct answer: Performing a full assessment, including checking for pain, repositioning the patient, and ensuring they are clean and dry.
For a non-verbal patient, behaviors like restlessness and agitation are often communications of an unmet need. The nurse acts as an advocate by first performing a thorough assessment to rule out reversible causes like pain, a full bladder, constipation, or uncomfortable positioning before resorting to pharmacological interventions. While family input is valuable, the nurse's clinical assessment is the priority advocacy action.
Question 6: A patient's family informs the CHPN that their cultural beliefs require a specific washing ritual to be performed by the family at the bedside immediately after death. What is the nurse's most appropriate action to support this need?
- Politely inform the family about the hospice's standard post-mortem care procedures.
- Document the request and ensure the care team facilitates a private, respectful environment for the ritual. (Correct answer)
- Explain that such rituals can only be performed by the designated hospice spiritual coordinator.
- Suggest they perform the ritual at the funeral home to avoid disrupting other patients or staff.
Correct answer: Document the request and ensure the care team facilitates a private, respectful environment for the ritual.
A core principle of holistic, patient-centered care is to support and facilitate the patient's and family's cultural and spiritual practices. The nurse's role is to act as an advocate by communicating this request to the interdisciplinary team, ensuring privacy, and accommodating the family's needs respectfully whenever possible. The other options create barriers and are not supportive of culturally sensitive care.
CHPN - Certified Hospice and Palliative Nurse Education, Support, and Advocacy Questions and Answers
A hospice patient with a valid Physician Orders for Life-Sustaining Treatment (POLST) form indicating "Do Not Hospitalize" develops a fever and urinary symptoms.
The patient's distressed adult child demands the patient be sent to the emergency room.
What is the CHPN's primary advocacy role in this situation?