CHPN CHPN - Certified Hospice and Palliative Nurse Patient Assessment and Planning Questions and Answers 2 — Questions and Answers
Question 1: A hospice nurse is assessing a patient with end-stage heart failure who reports increasing dyspnea at rest. Which intervention should be prioritized in the plan of care?
- Initiate continuous pulse oximetry monitoring
- Administer low-dose opioids for symptom relief (Correct answer)
- Recommend cardiac rehabilitation exercises
- Schedule an echocardiogram for reassessment
Correct answer: Administer low-dose opioids for symptom relief
Low-dose opioids are a first-line palliative intervention for dyspnea in end-stage heart failure, reducing the sensation of breathlessness without necessarily improving oxygen levels.
Question 2: During a comprehensive hospice admission assessment, the nurse identifies that a patient's primary caregiver is showing signs of burnout. Which action best reflects appropriate care planning?
- Document the observation and reassess at the next visit
- Refer the caregiver to respite care services and support resources (Correct answer)
- Advise the caregiver to hire private-duty nursing assistance
- Recommend the patient be transferred to an inpatient hospice facility
Correct answer: Refer the caregiver to respite care services and support resources
Referring the caregiver to respite care and support resources addresses caregiver burnout proactively while maintaining the patient's preferred care setting.
Question 3: A patient with advanced dementia is grimacing, moaning, and resisting care during repositioning. The patient is unable to verbally report pain. Which assessment tool is most appropriate?
- Numeric Rating Scale (NRS)
- Visual Analog Scale (VAS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Brief Pain Inventory (BPI)
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
The PAINAD scale is specifically designed for patients with advanced dementia who cannot self-report pain, using observable behavioral indicators.
Question 4: When developing a plan of care for a hospice patient from a cultural background that values family decision-making over individual autonomy, the nurse should first:
- Insist on speaking privately with the patient to confirm their wishes
- Follow the family's directives without consulting the patient
- Assess the patient's preferred level of involvement in decision-making (Correct answer)
- Document that the patient lacks decision-making capacity
Correct answer: Assess the patient's preferred level of involvement in decision-making
Assessing the patient's preferred level of involvement respects both cultural values and individual autonomy by letting the patient define how decisions should be made.
Question 5: A hospice nurse is planning care for a patient with a PPS (Palliative Performance Scale) score of 30%. Which finding is most consistent with this score?
- The patient is ambulatory with occasional assistance needed
- The patient is mainly bedbound with extensive assistance required for self-care (Correct answer)
- The patient is able to do significant work activity with some disease evidence
- The patient requires total care and is completely bedbound with no oral intake
Correct answer: The patient is mainly bedbound with extensive assistance required for self-care
A PPS score of 30% indicates a patient who is mainly bedbound, unable to do any activity, requiring extensive assistance, and having reduced oral intake.
Question 6: Which assessment finding would prompt the hospice nurse to initiate a discussion about updating a patient's advance directive?
- The patient's pain level has increased from 3 to 5 on the numeric scale
- The patient has experienced a significant decline in functional status over the past week (Correct answer)
- The patient's family is requesting more frequent nursing visits
- The patient's medication regimen requires adjustment for symptom control
Correct answer: The patient has experienced a significant decline in functional status over the past week
A significant decline in functional status often signals disease progression and warrants revisiting goals of care and advance directive preferences.
CHPN CHPN - Certified Hospice and Palliative Nurse Patient Assessment and Planning Questions and Answers 2
A hospice nurse is assessing a patient with end-stage heart failure who reports increasing dyspnea at rest.
Which intervention should be prioritized in the plan of care?