CHPN - Certified Hospice and Palliative Nurse Patient Assessment and Planning Questions and Answers — Questions and Answers
Question 1: A hospice nurse is using the Palliative Performance Scale (PPS) to assess a new patient. The patient is mainly sitting or lying down, unable to do any work, has extensive disease, and requires considerable assistance with self-care. They are able to take normal to reduced oral intake and have a full level of consciousness. Which PPS level BEST represents this patient's status?
- 70%
- 50% (Correct answer)
- 30%
- 10%
Correct answer: 50%
A PPS score of 50% is appropriate for a patient who is mainly sitting or lying down, unable to perform any work, has extensive disease, and requires considerable assistance with self-care, but still has relatively normal or only somewhat reduced oral intake and a full level of consciousness. A 70% level indicates reduced ambulation, while 30% and 10% levels involve being totally bed-bound with more severe limitations in intake and consciousness.
Question 2: When conducting an initial patient assessment, the hospice nurse utilizes the Edmonton Symptom Assessment System (ESAS). What is the primary purpose of this tool?
- To determine the patient's eligibility for hospice services.
- To measure the patient's functional and ambulatory status.
- To assess the severity of nine common symptoms from the patient's perspective. (Correct answer)
- To document the patient's advance care planning decisions.
Correct answer: To assess the severity of nine common symptoms from the patient's perspective.
The Edmonton Symptom Assessment System (ESAS) is a validated tool used to assess the severity of nine common symptoms in palliative care, such as pain, tiredness, nausea, depression, and anxiety, rated on a scale from 0 to 10. Its primary purpose is to capture the patient's subjective experience of these symptoms to guide management, not to determine hospice eligibility, measure functional status (like the PPS), or document advance directives.
Question 3: Which of the following is the MOST critical initial step in the advance care planning process for a new hospice patient who is capable of making decisions?
- Completing a Do Not Resuscitate (DNR) order immediately.
- Having the patient sign a living will and durable power of attorney for health care.
- Identifying a healthcare proxy or surrogate decision-maker.
- Engaging the patient in a conversation about their values, goals, and preferences for care. (Correct answer)
Correct answer: Engaging the patient in a conversation about their values, goals, and preferences for care.
The most critical initial step in advance care planning is to have a meaningful conversation with the patient to understand their values, goals, and wishes for future medical care. This conversation provides the foundation for all subsequent documentation, such as living wills or the appointment of a healthcare proxy. Rushing to complete forms without this understanding can lead to care that does not align with the patient's true preferences.
Question 4: A 78-year-old male with end-stage COPD is admitted to hospice. During the initial psychosocial assessment, which area is MOST important for the nurse to explore to develop a holistic plan of care?
- The patient's past employment history and career achievements.
- The family's financial resources and insurance coverage.
- The patient's current coping mechanisms, support systems, and spiritual beliefs. (Correct answer)
- The detailed history of the progression of his physical disease.
Correct answer: The patient's current coping mechanisms, support systems, and spiritual beliefs.
A holistic psychosocial assessment in palliative care prioritizes understanding the patient's current emotional state, their sources of strength and support (family, friends), their coping strategies for dealing with their illness, and any spiritual or existential concerns. While financial resources and disease history are part of the comprehensive assessment, the core of the psychosocial domain focuses on the patient's and family's emotional, social, and spiritual well-being to address potential distress.
Question 5: According to the Medicare Conditions of Participation, a comprehensive assessment for a new hospice patient must be completed by the interdisciplinary group (IDG) within how many days of the election of hospice care?
- 24 hours
- 48 hours
- 5 calendar days (Correct answer)
- 15 calendar days
Correct answer: 5 calendar days
The Medicare Conditions of Participation mandate that the hospice interdisciplinary group (IDG) must complete a comprehensive assessment for each patient within 5 calendar days after the election of hospice care. The initial nursing assessment must be done within 48 hours, but the full IDG comprehensive assessment has a 5-day timeframe.
Question 6: A patient with advanced dementia is being assessed for hospice care. The nurse notes that the patient is bed-bound, requires total care for all activities of daily living, is largely non-verbal, and has minimal oral intake, primarily receiving sips for comfort. This clinical presentation aligns with which prognostic indicator tool?
- Edmonton Symptom Assessment System (ESAS)
- Functional Assessment Staging Test (FAST) (Correct answer)
- Braden Scale
- Morse Fall Scale
Correct answer: Functional Assessment Staging Test (FAST)
The Functional Assessment Staging Test (FAST) scale is specifically designed to stage the progression of dementia. The scenario describes characteristics of stage 7 of the FAST scale, which includes loss of ambulation, inability to sit up independently, loss of speech, and difficulty swallowing, all of which are key prognostic indicators for hospice eligibility in patients with advanced dementia. The other tools assess symptoms (ESAS), pressure ulcer risk (Braden), and fall risk (Morse).
CHPN - Certified Hospice and Palliative Nurse Patient Assessment and Planning Questions and Answers
A hospice nurse is using the Palliative Performance Scale (PPS) to assess a new patient.
The patient is mainly sitting or lying down, unable to do any work, has extensive disease, and requires considerable assistance with self-care.
They are able to take normal to reduced oral intake and have a full level of consciousness.
Which PPS level BEST represents this patient's status?