CHPN CHPN - Certified Hospice and Palliative Nurse Education, Support, and Advocacy Questions and Answers 2 — Questions and Answers
Question 1: A hospice nurse is educating a family about the signs of imminent death. Which of the following is the MOST appropriate information to include?
- The patient will likely experience increased appetite in the final hours
- Mottling of the skin and changes in breathing patterns are expected (Correct answer)
- The patient should be repositioned every hour to prevent pressure ulcers
- Intravenous fluids should be increased to maintain hydration
Correct answer: Mottling of the skin and changes in breathing patterns are expected
Mottling of the skin and irregular breathing patterns such as Cheyne-Stokes respirations are common signs of imminent death that families should be educated about.
Question 2: When advocating for a hospice patient whose family insists on aggressive interventions inconsistent with the patient's advance directive, the nurse should FIRST:
- Contact the ethics committee immediately
- Review the advance directive with the family and clarify the patient's documented wishes (Correct answer)
- Administer the aggressive interventions as the family requests
- Discharge the patient from hospice services
Correct answer: Review the advance directive with the family and clarify the patient's documented wishes
The nurse's first step should be to review the advance directive with the family, ensuring they understand the patient's previously expressed wishes.
Question 3: A hospice nurse is providing education to a newly admitted patient's caregiver about managing breakthrough pain. Which statement by the caregiver indicates a need for further teaching?
- I should give the rescue dose when pain increases beyond the baseline
- I will document the time and effectiveness of each rescue dose
- I should wait until the next scheduled dose because extra medication will cause addiction (Correct answer)
- I understand the rescue medication works faster than the long-acting one
Correct answer: I should wait until the next scheduled dose because extra medication will cause addiction
Fear of addiction is a common misconception among caregivers; breakthrough pain medication should be administered as prescribed without withholding due to unfounded addiction concerns.
Question 4: In the context of hospice care, which action BEST demonstrates the nurse's role as a patient advocate during an interdisciplinary team meeting?
- Deferring all decisions to the attending physician
- Presenting the patient's stated goals and preferences to guide the care plan (Correct answer)
- Focusing exclusively on the medical treatment options available
- Recommending transfer to acute care for further diagnostic workups
Correct answer: Presenting the patient's stated goals and preferences to guide the care plan
Advocating for the patient means ensuring their goals, values, and preferences are central to care planning discussions within the interdisciplinary team.
Question 5: A hospice nurse is educating a patient's spouse about the purpose of palliative sedation. Which explanation is MOST accurate?
- Palliative sedation is used to hasten death when suffering becomes unbearable
- It is intended to reduce consciousness to relieve refractory symptoms at end of life (Correct answer)
- Palliative sedation replaces all other comfort measures once initiated
- It is only used when the patient can provide verbal consent at the time of administration
Correct answer: It is intended to reduce consciousness to relieve refractory symptoms at end of life
Palliative sedation aims to reduce awareness to alleviate refractory symptoms that have not responded to other interventions, not to hasten death.
Question 6: Which strategy is MOST effective for a hospice nurse supporting a family from a culture that traditionally does not discuss death openly with the patient?
- Insist that the patient must be told their prognosis to comply with hospice regulations
- Respect the family's cultural norms while exploring the patient's own preferences privately (Correct answer)
- Avoid all discussions about prognosis with the patient and family
- Document that the family is non-compliant with hospice education protocols
Correct answer: Respect the family's cultural norms while exploring the patient's own preferences privately
Culturally sensitive care involves respecting family norms while still seeking to understand and honor the individual patient's own wishes regarding disclosure.
CHPN CHPN - Certified Hospice and Palliative Nurse Education, Support, and Advocacy Questions and Answers 2
A hospice nurse is educating a family about the signs of imminent death.
Which of the following is the MOST appropriate information to include?