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

The nurse's primary duty is to advocate for the patient's autonomy and previously expressed wishes. A valid advance directive is the legal documentation of these wishes. When a conflict arises between the directive and the proxy's decision, the nurse should uphold the directive, explain the situation to the family, and involve the interdisciplinary team and an ethics committee to mediate and clarify the plan of care.

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

The CHPN's role in the IDG is often to coordinate care and facilitate collaboration. The most effective action is to foster a discussion that respects the expertise of both the social worker and chaplain, aiming to create a comprehensive plan that addresses the patient's multifaceted distress from both perspectives rather than choosing one over the other.

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

The Medicare Conditions of Participation (CoPs) at 42 CFR § 418.64 mandate that a hospice's organized bereavement program must make services available to the family and others identified in the bereavement plan of care for up to one year (12 months) following the death of the patient.

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

Professional nursing ethics and organizational policies generally prohibit nurses from accepting significant or valuable gifts from patients or families. Doing so can blur professional boundaries and create a perception of favoritism or obligation. The most appropriate action is to graciously decline, express gratitude for the sentiment, and explain the professional and policy-based reasons for not accepting it, thereby preserving the integrity of the nurse-patient relationship.

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

While cultural sensitivity is paramount, the nurse's primary ethical obligation is to the patient's right to self-determination. The most appropriate first step is to assess the patient's own wishes regarding information disclosure. Many individuals, even within collectivist cultures, may wish to know their prognosis. This approach respects both cultural norms and individual autonomy by allowing the patient to guide the communication process.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

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