CHPN - Certified Hospice and Palliative Nurse Education, Support, and Advocacy 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?

Accepted Answer

Gently reorient the family to the patient's stated wishes on the POLST form and explore their underlying fears.

Answer

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?

Accepted Answer

That changes like mottling, altered breathing patterns, and decreased socialization are a normal part of the process.

Answer

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?

Accepted Answer

"What you are describing is very common and is known as anticipatory grief. It's okay to talk about these feelings."

Answer

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?

Accepted Answer

"Keep a detailed, written log of every dose given, including the date, time, and amount."

Answer

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?

Accepted Answer

Performing a full assessment, including checking for pain, repositioning the patient, and ensuring they are clean and dry.

Answer

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.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Education, Support, and Advocacy Questions and Answers