CHPN - Certified Hospice and Palliative Nurse Professional Practice Issues Questions and Answers

Question 1

A hospice patient has a legally valid advance directive that explicitly refuses artificial nutrition and hydration.
The patient can no longer swallow, and their family, who is the healthcare proxy, is now demanding the insertion of a feeding tube, stating, 'We've changed our minds.' What is the CHPN's primary ethical and legal responsibility in this situation?

Accepted Answer

Advocate for the patient's wishes as stated in the advance directive and initiate an ethics consultation.

Answer

Follow the family's wishes as the healthcare proxy to avoid conflict.

Answer

Inform the family that the hospice must discharge the patient if they insist on the feeding tube.

Answer

Proceed with the feeding tube insertion as the proxy's decision overrides the advance directive.

Question 2

During an interdisciplinary group (IDG) meeting, the social worker and the chaplain express differing opinions on the primary source of a patient's existential distress, leading to a debate on the best approach for psychosocial support. Which of the following actions BEST describes the CHPN's role as the care coordinator?

Accepted Answer

Facilitate a collaborative discussion, seeking to integrate both perspectives into a holistic plan of care.

Answer

Ask the medical director to make the final decision to save time.

Answer

Side with the discipline that has the longest-standing relationship with the patient.

Answer

Postpone the discussion to the next meeting to allow for tempers to cool.

Question 3

According to the Medicare Conditions of Participation for hospice, for how long must the hospice agency make bereavement services available to the patient's family and other identified individuals following the patient's death?

Accepted Answer

For up to 12 months.

Answer

For up to 3 months.

Answer

For up to 6 months.

Answer

For at least 18 months.

Question 4

A CHPN has provided care for a patient for nearly a year. After the patient's death, the grieving family offers the nurse a valuable piece of jewelry, stating, 'You were like family to us, and we want you to have this.' What is the MOST appropriate initial action for the nurse?

Accepted Answer

Politely decline the gift, explaining agency policy while affirming the therapeutic value of the relationship.

Answer

Accept the gift to avoid hurting the family's feelings during their time of grief.

Answer

Suggest the family donate the item to the hospice agency in the nurse's name.

Answer

Accept the gift but report it to a supervisor to ensure transparency.

Question 5

A CHPN is caring for a patient whose cultural background values familial decision-making. The family requests that the patient not be told their terminal prognosis directly to 'protect them from fear.' The patient is alert and oriented. What is the nurse's most culturally sensitive and ethical first step?

Accepted Answer

Gently ask the patient about their preferences for receiving medical information and who they would like involved in decisions.

Answer

Agree to the family's request to honor their cultural values.

Answer

Inform the family that withholding information is against hospital policy and the principle of autonomy.

Answer

Document the family's request and follow it without speaking to the patient about the matter.

Question 6

A patient with refractory symptoms at the end of life is started on palliative sedation. The CHPN administers medication with the primary intention of relieving suffering, even though a potential, unintended consequence could be the hastening of death. This action is ethically supported by which of the following principles?

Accepted Answer

The principle of double effect

Answer

Beneficence

Answer

Justice

Answer

Paternalism